Systematic review on the effectiveness of strategies to identify and guide management in primary care for patients at familial cancer risk: a protocol

Problem

Early identification of patients with familial cancer risk enables access to preventative measures such as increased surveillance, risk reduction surgery, and chemoprevention. These measures can reduce the incidence, mortality, and morbidity of familial cancer and subsequently save the NHS cost. Therefore primary care providers (PCPs) play an imperative role in identifying patients at familial cancer risk. Previous research has suggested PCP’s lack confidence in managing patients at risk of familial cancer due to not knowing the referral criteria. Studies have evaluated strategies to overcome this, such as using computer decision aids. A systematic review to summarise the effectiveness of strategies used to identify and guide management in primary care for patients at familial cancer risk compared to usual care would help policy makers decide which strategies are worth considering. A preliminary search on Cochrane, Joanna Briggs Institute and PROSPERO database found no similar systematic review.

Approach

We will use the standard systematic review methods of The Cochrane Collaboration and PRISMA. We searched Medline, Embase, CINAHL, Cochrane library from 1980s onwards for articles published in English. The search terms will be based on the concepts of ‘breast, ovarian, colorectal, prostate cancer’, ‘familial/ hereditary cancer’ and ‘primary health care’.Familial cancers included are: breast, ovarian, colorectal and prostate. Only strategies conducted by PCPs in a primary care or community health setting will be included; studies based in specialist settings or interventions undertaken by specialists in a community setting will be excluded. Participants must not have a previous diagnosis of cancer or known genetic mutation.Study design included are randomised controlled trials (RCTs), cluster RCTs, and non-randomised studies for interventions (NRSIs). Primary outcomes assessed are: 1. cancer incidence, cancer related morbidity, mortality and survival analysis; 2. identification of cancer predisposition. Screening will be performed by two authors independently.For the assessment of methodological quality, the Cochrane Collaboration’s tool for assessing risk bias will be used for RCTs and the ROBINS-I tool will be used for NRSIs. Where possible, we will pool the studies in statistical meta-analysis. Sensitivity analysis will be performed to assess the impact of methodological quality on the meta-analysis. A summary of findings table will be created following the GRADE approach.

Findings

At the time of writing, the literature search have identified 18 738 papers. After duplicates removal, 11 841 papers were subjected to the title and abstract screening stage.

Consequences

This systematic review will help policy makers decide which strategies are worth considering for further evaluation in trials or for large scale implementation. It will also help researchers identify the evidence gap and inform the design of future trials.