Computer support for recording and interpreting family histories of breastand ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients

Objectives To explore general practitioners' attitudes ton ards and use of a computer program for assessing genetic risk of cancer in primary care. Design Qualitative analysis of semistructured interviews and video recordin gs of simulated consultations. Participants Purposive sample of 15 general practitioners covering a range of computer literacy; interest in genetics, age, and sex. Interventions Each doctor used the program in two consultations in which an actor played a woman concerned about her family history of cancer. Consult ations were videotaped and followed by interviews with the video as a promp t to questioning, Main outcome measures Use of computer program in the consultation. Results The program was viewed as an appropriate application of information technology because of the complexity of cancer genetics and a sense of "gu ideline chaos" in primary care. Doctors found the program easy to use, but it often affected their control of the consultation. They needed to balance their desire to share the computer screen with the patient, driven by thei r concerns about the effect of the computer on doctor-patient communication against the risk of premature disclosure of bad news. Conclusions This computer program could provide the necessary. support to a ssist assessment of genetic risk of cancer in primary care. The potential i mpact of computer software on the consultation should not be underestimated . This study highlights the need for careful evaluation when developing med ical information systems.