RAGs: A novel approach to computerized genetic risk assessment and decision support from pedigrees

Objectives. To assist general practitioners in evaluating patients' genetic risk of cancer on the basis of family history data. Methods: A new computer application, RAGs (Risk Assessment in Genetics), ha s been developed to help doctors create graphical family trees and assess t he genetic risk of breast and colorectal cancer. RAGs possesses two feature s that distinguish it from similar software: (i) a user-centred design, whi ch takes into account the requirements of the doctor-patient encounter, (ii ) effective and accessible risk reporting by employing qualitative evidence for or against increased risk, which is more easily understood than numeri cal probabilities. The system allows any rule-based genetic risk guideline to be implemented, and may be readily modified to cater for the varying deg rees of information required by different specialists. Results: RAGs permits fast, accurate data entry, and results in more approp riate management decisions than those made via other techniques. In additio n, RAGs enables both the clinician and the patient to understand how it arr ives at its conclusions, since the use of qualitative evidence allows the p rogram to provide explanations for its reasoning. Conclusions: The RAGs system promises to help practitioners be more effecti ve gatekeepers to genetic services. It may empower doctors both to make an informed choice when deciding to refer patients who are at increased geneti c risk of breast or colorectal cancer, and to reassure those who are at low risk.