Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: A multi-methods study

• Published in: PloS one 2020-03, Vol.15 (3), p.e0229999
• Main Authors: Archer, Stephanie, Babb de Villiers, Chantal, Scheibl, Fiona, Carver, Tim, Hartley, Simon, Lee, Andrew, Cunningham, Alex P, Easton, Douglas F, McIntosh, Jennifer G, Emery, Jon, Tischkowitz, Marc, Antoniou, Antonis C, Walter, Fiona M
• Format: Article
• Language: English
• Subjects: Acceptability; Adult; Algorithms; Biology and Life Sciences; Breast cancer; Breast Neoplasms - diagnosis; Cancer; Cancer research; Clinics; Computer simulation; Data collection; Design; Development and progression; Engineering and Technology; Epidemiology; Evaluation; Family medical history; Female; Genetic aspects; Genetics; Health aspects; Health care; Health Personnel - psychology; Health risks; Humans; Intervention; Male; Medical research; Medicine and Health Sciences; Methods; Middle Aged; Ovarian cancer; Ovarian carcinoma; Ovarian Neoplasms - diagnosis; People and places; Prediction models; Primary care; Primary care nursing; Primary Health Care; Prototypes; Public health; Qualitative analysis; Questionnaires; Risk; Risk analysis; Risk assessment; Risk communication; Risk factors; Self Efficacy; Setting (Literature); Studies; Time; User-Computer Interface; Web site management software
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229999

There is a growing focus on the development of multi-factorial cancer risk prediction algorithms alongside tools that operationalise them for clinical use. BOADICEA is a breast and ovarian cancer risk prediction model incorporating genetic and other risk factors. A new user-friendly Web-based tool (CanRisk.org) has been developed to apply BOADICEA. This study aimed to explore the acceptability of the prototype CanRisk tool among two healthcare professional groups to inform further development, evaluation and implementation. A multi-methods approach was used. Clinicians from primary care and specialist genetics clinics in England, France and Germany 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 examined via a semi-structured interview or equivalent open-ended questionnaire. Qualitative data were subjected to thematic analysis and organised around Sekhon's Theoretical Framework of Acceptability. Seventy-five clinicians participated, 21 from primary care and 54 from specialist genetics clinics. Participants were from England (n = 37), France (n = 23) and Germany (n = 15). The prototype CanRisk tool was generally acceptable to most participants due to its intuitive design. Primary care clinicians were concerned about the amount of time needed to complete, interpret and communicate risk information. 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 findings highlight the challenges associated with developing a complex tool for use in different clinical settings; they also helped refine the tool. This prototype may not have been versatile enough for clinical use in both primary care and specialist genetics clinics where the needs of clinicians are different, emphasising the importance of understanding the clinical context when developing cancer risk assessment tools.