Table 4.

Moving genetic testing into the mainstream

Maintain communication

I think the genetics services and the cancer services, I think we need a more cohesive approach, we need a better understanding of what each of us is thinking. CG3

We have quite a lot of informal, I mean mostly with name in clinical genetics team quite a lot of informal positive contact. But no, we live in slightly different worlds. Which is a shame O4

[I would like to] have an opportunity to sit down with the people who do that discussion now and make sure that my amateur version of it is covering the same ground…. I could do with like a little chat from the genetics service folk and maybe refreshers or an ongoing conversation from time to time to make sure we don’t diverge our approach as the service develops’. O3

I think mainstreaming could happen very quickly, it just requires us as a group of oncologists to sit down and have that other conversation. We don’t meet all of us terribly often because half of them do clinics outside so there aren’t many days a week when all of us, are actually here.…We have meetings about every three months and there always seem to be more pressing, urgent issues to resolve. I guess we just need to put it on the agenda for the next one. It’s just, it’s getting everybody in the room and agreeing, and having the conversation and people being comfortable. O4

Identify speciality champions

If someone is in a department, you know, in renal or something and they’ve got a particular interest in genetics then it makes a massive difference CG5

You need champions. I think all mainstreaming you need a champion in the mainstream specialty that wants to work with you, because only they really know how it fits with their way of working, their colleagues. We don’t know, we think we know what they want, and we have asked them, we keep asking them, we haven’t just invented it in a vacuum. I think you need to be in the specialty to understand the psychology of the specialty, really. And that’s strange. You know, our best, our best links with other specialties are when we’ve got a champion. CG4

Develop clear guidance

Work on any pathway, particularly something that’s probably got variable input is quite good to try and set it out clearly, particularly from the patient’s point of view, the patient expectation, so if you set out a clear pathway the patient then trundles along quite gently and quietly and knows what’s going on and you get less anxiety and less uncertainty and therefore less questioning and therefore less time taken up by the professional. If the pathway is well set out and well organized, I think generally you get less fall out from it which you as the consultant have to pick up. And I think from our point of view it’s better if there is a well set up pathway because then all the right people go into that pathway. So the more you know about, as a professional about the pathway and how it’s set out the better you use it basically. And if it’s a well thought out, well set up pathway then the patients will get the best out of it without causing more work. O1

I know they produce guidelines of what people we’ll refer,.. but I’ve been onto them clinical genetics team about this a number of times, that we lack very good genetic tools. There are some online assessment tools. But sometimes we could do, you know, there are apps for everything. We need better apps for genetic testing. You know, identifying which patients should be genetically tested. S2