Table 2.

The surgical team’s perceptions of TFGT

Role responsibility: Treating cancer

We’re there to diagnose their lumps and treat them. But in the middle of the thing we’re being asked to do all this stuff TFGT as well. And I think that’s becoming pretty difficult to do. ‘Cause we’re mainly interested if you come with a lump. You want to know what your lump is. We’d want to do all the investigations that day, work out what it is. And that’s what the focus is. S2

The genetics team wanted us to do all this this rapid testing. It’s because they’re overwhelmed, they just want to get us to spend the time talking to the patients about it. Yeah of course we want more patients assessed than we used to, for obvious reasons, but we don’t have the time or skills to counsel people about gene testing. We wouldn’t dream of asking a geneticist to counsel people about breast surgery S6

Redesigning the care pathway: Mainstreaming TFGT will increase workload beyond capacity

When you looked at the numbers it mainstreaming was going to add up to hundreds of hours a year that we just don’t have time or staff to do. Which is exactly why they genetics wanted us to do it, because they don’t have the time or staff to do it either S5

We had about 35 patients in our clinic this morning between two people. In my afternoon follow-up clinic I’ve got 14, 16 patients coming between two and half-four or something, so you cannot stop for 40 min to have a chat with somebody about consenting for gene testing on top of everything else you’re doing. S3

Relevance for practice: TFGT less relevant for surgical practice

Quite often we feel that the priority is treating the cancer. So we could do a smaller surgical procedure to deal with the cancer initially. The patient could then have chemotherapy if appropriate. And then if the genetic testing showed that they carried a mutation, then we could consider more radical surgery later on. S1

It’s the cancer, treating the cancer should be the first priority. Because when you know that the patient’s BRCA, surgically what you are doing is prevention, not treatment. So the first thing is to treat the cancer, the prevention of the secondary cancer, prevention of recurrence can be done, and then what you try to achieve is the best cosmetic result. S4