May direct-to-consumer genetic testing have an impact on general practitioners' daily practice? a cross-sectional study of patients' intentions towards this approach.

BACKGROUND: Direct-to-consumer genetic testing (DTCGT) offers individuals access to information on their probable risks of suffering from a wide range of chronic diseases. General practitioners (GPs) will probably play a major role in supporting its use, but patients' perception of DTCGT remain unclear. This study aimed to describe those attitudes and expectations and how they might affect GPs' daily practices. METHODS: In 2018-2019, a study related to the use of DTCGT for preventive care in general medicine was conducted among patients in Switzerland's French-speaking areas. Data were collected in the waiting room using a self-administrated questionnaire about patients' interest in DTCGT and what their attitudes might be if testing revealed an elevated risk of diabetes, colorectal cancer, or Alzheimer's disease. RESULTS: About 40% of the 929 participating (participation rate about 80%) patients had heard about DTCGT and, once the test had been explained, 43% reported that they would be interested in being tested. If that testing suggested an elevated risk of disease, the majority of patients reported that they would change their lifestyle (65%-81%, depending on the disease), request more examinations (63%-77%), and expect changes in their GP's follow-up (48%-59%). Personal characteristics such as sex, age, urbanity, marital status, and perceived health were factors predictive of patients' attitudes. CONCLUSION: Findings indicated that the generalization of DTCGT might affect GPs' daily practices in terms of workload and knowledge about this approach. However, this result must be qualified by the fact that it is based on hypothetical situations.

Médecine personnalisée et prévention des maladies chroniques : l'attitude des médecins généralistes.

OBJECTIVES: In a context of future generalization of access to genetic risk profiles, general practitioners (GP) will have a major role to play. The objective of this study was to understand their attitude towards this approach and the potential consequences on their practice. METHODS: In 2018, the University Center of General Medicine and Public Health of Lausanne, the Department of Primary Care Medicine of the University Hospitals of Geneva, and the Institute of Social Sciences of the University of Lausanne set up a study with patients and general practitioners concerning the access to genetic risk profiles. The GPs attitude, the subject of this study, was explored using the two-round Delphi consensus method. 120 interns and senior clinicians responded to 24 statements. RESULTS: A consensus was reached for 80% of the statements. The GP’s significant role in terms of access to genetic profiles became evident, even if their position seems conditioned by their position as front-line health workers, and doubts remain as to the impact of this process in guiding their practice. The need for training was widely emphasized as well as the possibility multidisciplinary support and management. There was also a consensus for the need of a legislative framework for these practices. CONCLUSION: This study has underlined the importance of anticipating the needs in developing an advanced and evolving training and information program for GPs in the domain of genomic medicine in light of the prevention activities that could result.

[Prevention and screening recommendations, from paper to electronic, a pilot project with a participative approach]. / Recommandations de préventionet de dépistage : du papierà l'électronique, un projet pilote avec approche participative.

Prevention and screening recommendations have to be adapted on a regular basis to the latest scientific data and should be completed by tools made to facilitated the implication of patients in decision-making. The prevention and screening webpages hosted on the website of the Department of community medicine and ambulatory care of the University of Lausanne facilitate access to clinical recommendations identified by members of the five medical faculties in Switzerland (EviPrev national program), and to various information sources for physicians and patients, including patient decision aids. These webpages have been developed with primary care physicians who have participated in a pilot project in the canton of Vaud. The webpages have also been tested and welcome by a participatory group of citizen-users.

Les recommandations de prévention et de dépistage doivent être régulièrement adaptées aux données scientifiques et souvent accompagnées d'outils développés pour faciliter l'implication des patients dans la prise de décision. Dans cette perspective, les pages web de prévention et de dépistage du site de la Policlinique médicale universitaire (PMU) de Lausanne facilitent l'accès aux recommandations cliniques, identifiées par des membres des cinq facultés de médecine en Suisse (programme national EviPrev), et à diverses sources d'information pour médecins ou patients, y compris des aides à la décision. Ces pages web ont été développées avec des médecins de famille ayant participé à un projet pilote du canton de Vaud. Testées auprès du groupe participatif d'usagers-citoyens, ces pages web ont rencontré un très bon accueil de leur part.

[Design and user-testing of a decision aid comparing medications for smoking cessation]. / Outil d'aide à la décision comparant les traitements pharmacologiques pour l'arrêt du tabac.

Medications for smoking cessation, such as nicotine replacement, bupropion and varenicline have comparable efficacy, but present different advantages and drawbacks, making patient-specific preferences important when choosing a medication for smoking cessation. Through 3 PDCA cycles (Plan-Do-Check-Act), we developed and user-tested a decision aid for use during consultations. It contains the most relevant information for choosing a smoking cessation medication and is freely available online. The methodology used for its development could be employed for other decision aids for preference-sensitive decisions.

Les médicaments d'aide au sevrage tabagique tels que les substituts nicotiniques, le bupropion et la varénicline présentent une efficacité comparable mais des avantages et inconvénients différents dus à leur mécanisme d'action. Pour augmenter l'adhérence au traitement et les chances de réussite d'un sevrage tabagique, il est important de définir les préférences de traitement du patient. Pour soutenir cette démarche, au cours de 3 cycles PDCA (Plan-Do-Check-Act), nous avons développé et testé un outil d'aide à la décision qui contient les informations jugées les plus pertinentes quant au choix du médicament pour arrêter de fumer. L'outil est disponible gratuitement sur internet. La méthodologie utilisée ici pourrait être appliquée pour le développement d'autres outils d'aide à la décision.

[Exercise-referral to a specialist in adapted physical activity (APA) : a pilot project]. / Délégation médicale vers un(e) spécialiste en activité physique adaptée (APA) : un projet pilote.

Family physicians have a key role in the promotion of physical activity, in particular in identifying and counseling persons who have a sedentary lifestyle. Some patients could benefit from intensive individual counseling. Physicians are often not aware of all physical activity promotion activities in the community that they could recommend their patients. In a pilot study, we have tested and adapted the referral of patients from family physicians to specialists in adapted physical activity (APAs). APAs are trained to assess and guide persons towards physical activities adapted to their needs and pathologies and thus towards an increase in physical activity. Pilot data suggest that, while few patients were oriented to the APAs in the pilot project, family physicians appreciate the possibility of collaborating with the APAs.

Les médecins de famille ont un rôle clé pour la promotion de l'activité physique, en particulier pour identifier et conseiller des personnes sédentaires. Certains patients pourraient bénéficier d'un accompagnement individuel plus intensif. Les offres d'activité physique dans la communauté ne sont pas toujours connues des médecins. Dans une étude pilote, nous avons testé et adapté la délégation de patients par des médecins de famille vers des spécialistes en activité physique adaptée (APAs). Les APAs sont formés à évaluer et accompagner des personnes vers des activités physiques adaptées à leurs besoins et pathologies et d'ainsi permettre une augmentation du niveau d'activité physique. Les données pilotes suggèrent que, si peu de patients ont été orientés vers les APAs, les médecins apprécient la possibilité de collaborer avec un APAs.

[Swiss recommendations for the check-up in the doctor's office]. / Schweizer Empfehlungen für den Check-up in der Arztpraxis.

Prevention and screening of diseases belong to the role of each primary care physician. Recommendations have been developed in the EviPrev programme, which brings together members of all five academic ambulatory general internal medicine centers in Switzerland (Lausanne, Bern, Geneva, Basel and Zürich). Several questions must be addressed before realising a prevention intervention: Do we have data demonstrating that early intervention or detection is effective? What are the efficacy and adverse effects of the intervention? What is the efficiency (cost-effectiveness) of the intervention? What are the patient's preferences concerning the intervention and its consequences? The recommendations aim at answering these questions independently, taking into account the Swiss context and integrating the patient's perspective in a shared decision-making encounter.

Citizen advisory groups for the creation and improvement of decision aids: experience from two Swiss centers for primary care.

BACKGROUND: Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users. METHODS: Between 2017 and 2020, two Swiss centers for primary care (Lausanne and Bern) created citizen advisory groups to contribute to multiple improvement cycles for colorectal, prostate and lung cancer screening DAs. Following Community Based Participatory Research principles, we collaborated with local organizations to recruit citizens aged 50 to 75 without previous cancer diagnoses. We remunerated incidental costs and participant time. One center supplemented in-person meetings by mailed paper questionnaires, while the other supplemented meetings using small-group workshops and analyses of meeting transcripts. RESULTS: In Lausanne, we received input from 49 participants for three DAs between 2017 and 2020. For each topic, participants gave feedback on the initial draft and 2 subsequent versions during in-person meetings with ~ 8 participants and one round of mailed questionnaires. In Bern, 10 participants were recruited among standardized patients from the university, all of whom attended in-person meetings every three months between 2017 and 2020. At both sites, numerous changes were made to the content, appearance, language, and tone of DAs and outreach materials. Participants reported high levels of satisfaction with the participative process. CONCLUSIONS: Citizen advisory groups are a feasible means of repeatedly incorporating end-user feedback during the creation of multiple DAs. Methodological differences between the two centers underline the need for a flexible model adapted to local needs.

Decision aids are paper or electronic tools that help people make medical decisions. They have been shown to help with shared decision making between patients, their loved ones, and a health professional. When we create decision aids, we try to involve patients at each step, traditionally using focus groups. However, new approaches are needed because focus groups take a lot of time and money.We developed a new method of involving people eligible for cancer screening and used this method during the development of four decision aids at two centers for research in primary care. Two of the decision aids were for colorectal cancer screening (one in French, one in German), and one each for prostate and lung cancer screening. We recruited people aged 50 to 75 interested in improving health information materials from community organizations and among standardized patients from local medical schools to form citizen advisory groups. Standardized patients act as patients during teaching sessions and exams. Some people took part in face-to-face meetings to give us feedback on the materials, while others responded to questionnaires and gave feedback by mail. The same participants gave feedback multiple times as we made improvements to the decision aids.The citizen advisory groups provided us with repeated, meaningful input during the development of decision aids. We think they allowed us to create better, more patient-centered decision aids, while using fewer resources than traditional focus groups. Other researchers who develop decision aids may want to use a similar approach.