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Research

Primary care online training on multifactorial breast cancer risk: pre–post evaluation study

Francisca Stutzin Donoso, Juliet A Usher-Smith, Lorenzo Ficorella, Antonis C Antoniou, Jon Emery, Marc Tischkowitz, Tim Carver, Douglas F Easton, Fiona M Walter and Stephanie Archer
BJGP Open 2025; 9 (3): BJGPO.2024.0305. DOI: https://doi.org/10.3399/BJGPO.2024.0305
Francisca Stutzin Donoso
1 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Francisca Stutzin Donoso
  • For correspondence: fsd26{at}cam.ac.uk
Juliet A Usher-Smith
1 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Juliet A Usher-Smith
Lorenzo Ficorella
2 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Lorenzo Ficorella
Antonis C Antoniou
2 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Antonis C Antoniou
Jon Emery
3 Centre for Cancer Research and Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
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  • ORCID record for Jon Emery
Marc Tischkowitz
4 Department of Genomic Medicine, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
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  • ORCID record for Marc Tischkowitz
Tim Carver
2 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Tim Carver
Douglas F Easton
2 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
5 Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
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Fiona M Walter
6 Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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  • ORCID record for Fiona M Walter
Stephanie Archer
7 Department of Psychology, University of Cambridge, Cambridge, UK
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1. (A-C) Pre–post training scores (n = 35)
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    Figure 2. Reactions to the training (n = 35)

Tables

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    Table 1. ‘Multifactorial breast cancer risk assessment in primary care’ online training
    Development of the trainingTraining objectivesDescription of the training
    • – Scoping review was led by FSD and the initial content plan was supported by subject matter experts from the CanRisk team (ACA, MT, JAUS, FMW, JE, SA).

    • – Content plan was reviewed by and discussed with members of our general practice expert advisory panel.

    • – The panel is composed of seven GPs and three practice nurses that support the development of the CanRisk Cancer Research UK programme grant (PPRPGM-Nov20\100002).

    1. To understand the basic components of the CanRisk multifactorial cancer risk prediction model.

    2. To recognise how genetic testing and multifactorial risk prediction for breast cancer works in practice.

    3. To communicate the results of multifactorial breast cancer risk prediction in primary care.

    4. To identify the outcomes and management options for each risk group identified through multifactorial breast cancer risk prediction.

    • – Four educational videos each covering one of the learning objectives featuring experts from the CanRisk team:

      • ACA in risk prediction;

      • MT in cancer genetics;

      • JE in risk communication in primary care; and

      • JAUS in cancer risk management in primary care.

    • – There is also a brief introduction video with an overview of training (SA) and a brief ‘main takeaway’ video summing up the content of the training and why it matters (FSD).

    • – The videos are 40 minutes long in total.

    • – The training also includes a selection of further relevant online educational resources from elearning for health care (e-lfh.org.uk).

    • Abbreviations refer to authors’ initials.

    • View popup
    Table 2. Characteristics of participants and GP practices
    N = 35%
    Participants
    Profession
    General Practitioner1851.42
    Practice Nurse1748.57
    Gender
    Female2262.85
    Male1337.14
    Age groups, years
    31–351337.14
    36–4038.57
    41–45720
    46–50514.28
    51–55411.42
    56–6025.71
    ≥6012.85
    Years of clinical experience
    1–5822.85
    6–101542.85
    11–15925.71
    16–2012.85
    ≥2025.71
    Previous training in genetics and/or cancer risk prediction tools
    Yes12.85
    No3497.14
    Specialisation or special interest
    Women’s health720
    Breast cancer411.42
    Genetics12.85
    Women’s health and breast cancer411.42
    Women’s health, breast cancer, and genetics411.42
    None of the above1542.85
    GP Practices
    Region
    West Midlands514.28
    Yorkshire and the Humber514.28
    South East514.28
    London411.42
    South West411.42
    North West411.42
    East of England38.57
    North East38.57
    East Midlands12.85
    Wales12.85
    Category
    Urban2571.42
    Mixed925.71
    Rural12.85
    Size (number of patients registered)
    0–5000514.28
    5001–10000822.85
    10001–150001131.42
    15001–20000514.28
    ≥20000617.14
    • View popup
    Table 3. Changes in objective knowledge, subjective knowledge, and confidence pre- and post-training (n = 35)
    Paired differencest-testSignificance
        95% confidence interval of the difference  
    Mean pre-trainingMean post-trainingDifference in the meanStandard deviationLowerUpper Two-sided P
    Objective knowledge6.6007.3710.7711.6990.1871.3552.686 0.011
    Subjective knowledge14.57121.4006.8284.8835.1508.5068.272<0.001
    Confidence12.82816.9144.0853.8452.7645.4066.286<0.001
    • View popup
    Table 4. Qualitative data analysis summary
    CategoryPositive feedbackPositive feedback example quotationsOpportunities for improvementOpportunities for improvement example quotations
    The content of the training
    • Highly informative and useful.

    • ‘It is an eye-opener programme and very educative.’ (p29 Female PN, North East)

    • ‘Very informative and detailed. Relevant and actionable steps that can be taken by primary care physicians.’ (p1 Male GP, London)

    • ‘Exceptionally educative and informative.’ (p15 Male PN, South East)

    • Demonstration of the CanRisk tool.

    • ‘It was good to understand how to interpret a CanRisk example report, but it would have been useful to also learn a bit more on how to access CanRisk, and a brief section on how to fill in the CanRisk questions in practice.’ (p19 Female GP, East Midlands)

    • ‘The opportunity to complete the CanRisk tool would be good.’ (p34, Female PN, Yorkshire and the Humber)

    • ‘Perhaps a demo of the CanRisk assessment procedure showing each drop-down section.’ (p23 Female PN, South West)

    The presentation of the training
    • Concise and accessible.

    • Clearly structured.

    • ‘Great succinct online learning, short and concise presentations, simple explanations of risk models and use of CanRisk.’ (p7 Male GP, North West)

    • ‘The training was simple and short but yet contained every detail needed for an improved practice as relating to my knowledge of breast cancer.’ (p21 Female PN, North West)

    • ‘Topic was very well explained in concise and timely manner and objective of learning were clear from start.’ (p9 Male GP, West Midlands)

    • ‘Very helpful focused work, with good section breakdown and rationale for each area of discussion.’ (p17 Male GP, North West)

    • Including simulations and case scenarios.

    • Providing handouts.

    • Accessibility issues.

    • ‘More interactive sessions and adding more real-life clinical cases to presentations.’ (p9 Male GP, West Midlands)

    • ‘I think some offline resources to go alongside would be helpful (like "handouts").’ (p18 Female GP, East of England)

    • ‘Some of the accents were more difficult to understand. At times it felt a little rushed with some of the more detailed slides moving on quickly.’ (p34, Female PN, Yorkshire and the Humber)

    • ‘It was difficult to read the slides on a mobile phone.’ (p6 Female GP, East of England)

    Relevance of the training
    • Relevant for primary care healthcare professionals.

    • Applicable to primary care.

    • Completing the training as a good opportunity.

    • ‘I was not previously aware of the CanRisk tool, and I am glad I am able to use this straightaway.’ (p2 Female GP, West Midlands)

    • ‘It was interesting and appropriate to my role as general practitioner.’ (p4 Female GP, West Midlands)

    • ‘Very happy I had the chance to do this, learnt a lot and feel well informed.’ (p16 Female PN, South West)

    • Concern about time.

    • Integration with clinical record system.

    • ‘My main concern is my ability to complete this depth of conversation within a 10-minute appointment slot. I wonder whether there is any scope to develop a questionnaire (or AccuRx type template) to gather the information needed to calculate a patient’s risk so that they can then be bought in for an appointment at a later stage.’ (p26, Female GP, South East)

    • ‘Does it incorporate into GP software such as EMIS and SystmOne? or is there coding available to document it?’ (p2 Female GP, West Midlands)

Supplementary Data

  • SD_10.3399BJGPO.2024.0305_supp_v1.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy. 

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Primary care online training on multifactorial breast cancer risk: pre–post evaluation study
Francisca Stutzin Donoso, Juliet A Usher-Smith, Lorenzo Ficorella, Antonis C Antoniou, Jon Emery, Marc Tischkowitz, Tim Carver, Douglas F Easton, Fiona M Walter, Stephanie Archer
BJGP Open 2025; 9 (3): BJGPO.2024.0305. DOI: 10.3399/BJGPO.2024.0305

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Primary care online training on multifactorial breast cancer risk: pre–post evaluation study
Francisca Stutzin Donoso, Juliet A Usher-Smith, Lorenzo Ficorella, Antonis C Antoniou, Jon Emery, Marc Tischkowitz, Tim Carver, Douglas F Easton, Fiona M Walter, Stephanie Archer
BJGP Open 2025; 9 (3): BJGPO.2024.0305. DOI: 10.3399/BJGPO.2024.0305
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Keywords

  • primary health care
  • e-learning
  • breast cancer
  • breast neoplasms
  • risk assessment

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