Table 5:

Barriers and facilitators of referral to genetic counselling and to high-risk screening programs

 EnvironmentProviders described the benefit of access to a comprehensive referral location such as a “breast clinic” or “genetics centre.”
“I find that’s when it’s nice to have everything through the high-risk clinic … they do a comprehensive intake, and they can coordinate the genetics piece.” — Participant 006
 Knowledge, skills, beliefs about capabilitiesFor providers aware of CCO forms, they found them useful and easy to complete.
 Belief about consequencesSome providers found referral processes for genetic counselling burdensome. They were confused about who qualifies (if unaware of forms), and felt that patients could fall through the cracks.
“And I’m finding that very burdensome, like, just knowing where to send them, or making sure I’m picking the right people to send”. — Participant 002
“[Referring to genetics] is hard and there’s not a lot of follow through. I’ve had patients fall through the cracks. Genetic actually wants — if there’s a living relative who had breast cancer, of course anywhere in North America, they want to use them as the index case to test, not your patient. I just find for me to facilitate it — data kind of gets lost and drags on and patients fall through.” — Participant 006
Primary care providers are charged a fee for “outside use” when rostered patients are seen by any other family physician (i.e., the family physicians with additional training who work at the breast clinics).
“So, I will refer my patients there [breast clinics], because I want the best for them, but it’s, it results in a bunch of outside use, so I’m paying for it.” — Participant 017
 Social and professional roleThere was confusion about the responsibilities of primary care providers versus genetic counsellors (in general and on the CCO form).
“And I had a look at that [form], and in category A, it talks about IBIS and BOADICEA. I’m a family doctor, I have no idea what those things are. Since I can’t answer those questions, I don’t think I can legally fill this form out … I could fill out part 2 of the form, which is the date and location and most recent mammogram, and any previous breast cancer.” — Participant 018
 Knowledge and skillsSome providers were not sure who warrants referral, or how to find or complete forms.
  • Note: BOADICEA = Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, CCO = Cancer Care Ontario, IBIS = International Breast Cancer Intervention Study.