2002) Also, the self-reporting nature of this study may be

2002). Also, the self-reporting nature of this study may be

affected by the tendency of female physicians to under-rate their own competence (Nomura et al. 2010). This is to our knowledge the first study in Europe of primary care providers’ attitudes to genetic management and how they relate to genetic education. Although the response rate was not high, this is a common problem for postal surveys and all appropriate methods were used to increase the response LY2874455 purchase rates. Databases from which samples were taken varied slightly between countries, but represented the only available national sources with doctors’ addresses and specialties. We recognise that we have studied self-reported rather than actual behaviour but analysis of actual behaviour would have been impossible to be organised practically and self-reporting

can be considered as a reliable proxy measure. Although the scenario used related only to one condition, sudden death from hypertrophic cardiomyopathy was selected as a scenario diagnosis specifically because it was unlikely to have featured in traditional Mendelian genetics teaching. The importance of genetics in its aetiology is, however, well recognised. We therefore suggest that it is likely to be a good model for common complex disorders with genetic aetiology encountered by primary care providers. We have previously demonstrated that genetic care by non-geneticists is patchy and often GSK461364 in vivo poorly documented (Lane et al. 1997; Williamson et al. 1997; Williamson et al. 1996a, b). This is supported by qualitative buy Neratinib research which found highly variable levels of information around referral and testing for Factor V CH5424802 in vitro Leiden (Saukko et al. 2007) and multiple potential barriers to effective communication amongst GPs providing antenatal counselling (Nagle et al. 2008).

Our work shows clearly that, apart from family history taking, many European GPs do not consider that “genetic” care should form part of their practice. Conclusions It is clear that given the significant effect of country of practice, independent of all other factors, on practitioner behaviour, recommendations on genetic education at all levels will have to be sensitive to country-specific issues. Educational structures and content will require tailoring to local priorities and learning conventions. Any standards of care for non-genetic specialists providing some aspects of genetic care will need to be appropriately contextualised into the local system of health care and health education and it is unlikely that a pan-European “one size fits all” policy will be immediately workable or acceptable. Acknowledgements Thanks to Karina Bertmaring, Daniel Cottam and Christine Waterman who provided invaluable administrative and data management support. The study was funded by European Community FP5 grant QLG4-CT-2001-30216. Conflicts of interest None.

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