Interactive decision support for risk management: a qualitative evaluation in cancer genetic counselling sessions

Abstract

Genetic counselling for inherited susceptibility to cancer involves communication of a significant amount of information about possible consequences of different interventions. This study explores counsellors' attitudes to computer software designed to aid this process. Eight genetic counsellors used the software with actors playing patients. Clinicians' rating of expected patient satisfaction, content, accuracy, timeliness, format, overall value, ease of use, effect on the patient-provider relationship and effect on clinician's performance were evaluated via qualitative and quantitative analysis of interviews, training tasks and questionnaires. Most counsellors found the software effective. Concerns related to possible impact on consultation dynamics and content. Participants suggested countering these through appropriate new counselling skills and selective use of the computer. The REACT software could provide effective support for genetic risk management counselling.

Fig. 1

The REACT user interface. A plan is being developed for risk mitigation by manipulating actions in the planning chart (top). The outcome measure graph (middle) indicates the estimated risk of breast cancer, while arguments for and against prophylactic oophorectomy for this patient are reviewed in the information panel (bottom)