Development and pilot-testing of a national audit of the use of the eviQ guidelines in Australian familial cancer clinics

April Morrow1,Rajneesh Kaur1, Bettina Meiser1, Michelle Peat1, Bhavya Vora1, Judy Kirk2, Annabel Goodwin3, Gillian Mitchell4

1Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia

2Familial Cancer Service, Westmead Institute for Cancer Research, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia

3Department of Cancer Medicine, Sydney Medical School, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

4Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.

Clinicalguidelinesaredeveloped to support clinician and patient decision-making, and to promote quality and consistency in healthcare. The eviQ Cancer Treatments Online guidelines (available from were developed in 2000 initially to provide point-of-care guidelines for cancer treatment, but extended in 2008 to include cancer genetics. In the familial cancer setting, eviQ uses current, evidence-based resources to provide standardised genetic testing thresholds and cancer risk management advice in an attempt to streamline clinical practice across Australia. Use of, and adherence to, the eviQ guidelines in familial cancer clinics has not yet been formally assessed.An initiative of the Inherited Cancer Connect Partnership (ICCon), this study aims to evaluatetheimpactoftheguidelinesonboth clinical practice and patient uptakeof risk management strategies byexaminingtimepoints before and afterguideline implementation.

There will be 11 participating familial cancer clinics across Australia (NSW=5, VIC=3, WA=1, SA=1, QLD=1). The study will consistof two stages. The first involves four different types of file audits to assess compliance with the following four eviQ cancer genetics guidelines:

  1. Genetic testing for heritable mutations in the BRCA1 and BRCA2 genes
  2. Risk management for unaffected female BRCA1 mutation carriers
  3. Risk management for unaffected female BRCA2 mutation carriers
  4. Risk management of Lynch syndrome

For each of the audits above,files from three different time periods will be selected to reflect time-points for comparison before and after the implementation of the eviQ guidelines. For each audit type and time period, 32 files will be selected randomly from each of the involved sites. An online checklist will then be completed to assess whether the offering of genetic testing or risk management recommendations were compliant with the eviQ guidelines at that time. The second stage will involve a short, semi-structured patient interviewby telephone to determine uptake of risk management strategies. Results will be analysed using descriptive statistics and chi-square analyses.

The methodology is currently being piloted at The Prince of Wales Hospital. The results of the pilot testing have not yet been analysed. If successful, we anticipate this study will identify inconsistencies in the use of, and adherence to, the eviQ guidelines across Australian familial cancer clinics. This may highlight areas of future research and the development of strategies to ensure consistency across clinics.