Table 2:

Barriers and facilitators of risk assessment

 Social influence of the patient on the provider“Of course, if they enquire about screening, I’d generally give that more attention with particular focus to their family history.” — Participant 007
 Behaviour regulation or reinforcementSome providers described that prompts or reminders at age 40 years would be helpful. Others stated it would be helpful, cumbersome or costly to add such prompts to the medical record.
 Knowledge of risk factors and risk assessment tools“I don’t know exactly. I definitely don’t exactly know what high risk is, except family history.” — Participant 001
 Skills to synthesize risk“Honestly I’ve tried to look into figuring out a formal percentage risk and I came across things like the IBIS score. When I’ve tried to figure out how to do that it’s been very difficult to figure out.” — Participant 017
 Beliefs about consequencesBelief that tools do not guide management or that genetic counsellors will provide screening recommendation in absence of a mutation.
“So, when I send patients [to genetics] who I think, they’re high risk and … could potentially warrant earlier mammography screening. And they’re not, I’m often surprised.” — Participant 014
 Environment, context and resourcesProviders described tools are cumbersome, time-consuming and difficult to use in real time.
“Yes, otherwise I think [the tool] is useless. If it spews something out to me but I don’t know how to interpret it or what the next step is… if I were to just calculate something and not know how to interpret it or not know how to implement it in practice, it probably wouldn’t be so useful.” — Participant 014
  • Note: IBIS = International Breast Cancer Intervention Study.