Multi-factorial cancer risk prediction algorithms, such as the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA), are being used to identify people at higher risk of cancer. CanRisk (www.canrisk.org) is a new web tool that allows healthcare professionals to apply BOADICEA in clinical settings. The MRC have published guidance on evaluating the effectiveness of complex interventions. One important aspect is testing how acceptable new tools are for their intended users. As such, we tested the acceptability of CanRisk with healthcare professionals from two clinical settings – primary care and specialist genetics clinics.
Our study, recently published in PLoS ONE, included healthcare professionals from England, France and Germany. Participants were invited to use the CanRisk prototype with two test cases, either face-to-face with a simulated patient or via a written vignette. Their views about the tool were collected via a semi-structured interview or equivalent open-ended questionnaire, and we used Sekhon’s Theoretical Framework of Acceptability to guide our analysis and interpretation.
We found that the prototype CanRisk tool was generally acceptable to most participants due to its intuitive design. Most clinicians from primary care had concerns about the amount of time needed to complete, interpret and communicate risk information. Some clinicians from both settings were apprehensive about the impact of the CanRisk tool on their consultations and lack of opportunities to interpret risk scores before sharing them with their patients.
The tool has now received its CE marking and is available for use, mainly in specialist genetics clinics – see more information and register to use the tool here. As our findings highlight the challenges associated with developing a complex tool for use in different clinical settings, we have made some features of the tool specific for clinical genetics clinic settings. We now have additional studies underway to refine the risk communication and risk management sections for primary care users. Once completed, we hope to see these changes made to the tool later in the year!