Box 2.

Additional exemplar quotes to support themes related to acceptability of risk-tailored cancer screening

Evidence of benefits for risk-tailored screening Benefits: ‘Tailoring would be good because it might mean that you’d focus on those higher-risk people and it might improve the pick-up rate for different conditions.’ (P15, 1–9 years’ experience) Evidence: ‘Look, I would happily follow guidelines. There just has to be enough sense behind them for me to feel comfortable arguing the case with the patient to say, “ Well we’ve been pursuing this as dogma, now we’re changing to this”, so I’d have to be comfortable with the science behind it.’ (P09, 20–29 years’ experience) Concern for the patient Confusing messages: ‘It’s all these mixed messages let alone for general practice, but for the public. So it [public health messaging] has to be carefully thought of rather than alarming the public about a change that can be confusing.’ (P01, 1–9 years’ experience) Patient responses: ‘Look, I can see that it would have its benefits, but I could see that it could have some negative impacts as well in terms of potentially increasing people’s anxiety about their risk.’ (P12, >30 years’ experience) Reservations related to own practice Impact on everyday practice: ‘I think the barriers are health system barriers, that is a time-based system, the lack of these sort of tools that are freely available in the workspace of general practitioners.’ (P01, 1–9 years’ experience) Issues related to genomic risk information: ‘Obviously [personal genomic risk information] is useful in theory. In practice, how do we ask those questions and then input them into some sort of algorithm in a timely manner?’ (P14, 1–9 years’ experience) Fears: ‘I have to admit that skin cancer is something that terrifies me. It’s one of my areas of weakness and I do end up actually referring a lot of my patients to a skin clinic for assessment these days so that I don’t miss anything.’ (P17, 10–19 years’ experience) Some cancers are more suited than others Cancer type: ‘I think especially breast cancer seems to fear lots and lots of women, so reducing screening or not screening at all I can see that would upset a lot of people.’ (P03, 1–9 years’ experience) Screening test: ‘I think perhaps because a colonoscopy is a lot more invasive than having a mammogram, people might be a little bit happier about saying, “ Oh great, I don’t have to have that again or I don’t have to have it every five years, every ten years.”’ (P09, 20–29 years’ experience) Engaging and enabling risk-tailored screening by GPs Education needs: ‘I think we do need better education around risk stratification, but not only about identifying high risk, but also what to do about those at low risk, so there’s a two-pronged educational aspect of it.’ (P01, 1–9 years’ experience) GP interest: ‘The biggest barrier would be just access to educating GPs about the change and the different data and why there may be a benefit.’ (P11, 1–9 years’ experience) Accessing evidence: ‘If you have the tools and education about a particular thing, it’s got to be a central area where the GPs have to access it. It’s got to be that resources are available for all those things so that if we have a patient in front of us that you’re worried about, then we can then say, “Okay, what’s the current thinking about it, what’s the current treatment? ”’ (P20, >30 years’ experience)