Building capacity for genomics in primary care: A scoping review of practitioner attitudes, education needs and enablers

Kate L.A. Dunlop^1,2*Nehal Singh^1*Amelia K Smit^1,2April L Morrow³Julia Steinburg²Anne E Cust^2,4Meredith Makeham¹Carissa Bonner¹Bronwyn Terrill^5,6Lynn Valerie Monrouxe¹David Wilkinson⁷Shailendra Sawleshwarkar¹Alan S Ma^1,8

• ¹The University of Sydney, Darlington, Australia
• ²The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Kings Cross, New South Wales, Australia
• ³The Centre for Genetics Education, NSW, Australia
• ⁴Melanoma Institute Australia, Sydney, New South Wales, Australia
• ⁵Australian Genomics Health Alliance, Melbourne, Australia
• ⁶University of New South Wales, Kensington, New South Wales, Australia
• ⁷Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
• ⁸Sydney Children's Hospital, Sydney, New South Wales, Australia

Introduction: Improving clinical capacity for genomics in primary care promises to lead to better health, but genomics uptake in the sector is slow and patchy. This review aimed to identify the attitudes of primary care practitioners (PCP), and education needs and enablers in applying genomics to inform priorities in education and implementation.: Searches were conducted across Medline, Scopus, CINAHL, Embase and Cochrane CENTRAL until November 2023. Barriers and enablers were mapped to the Theoretical Domains Framework, and the Genomic Medicine Integrative Research Framework.Results: 52 studies were included and the most frequently mapped domains from the Theoretical Domains Framework were 'Knowledge' (65.4% of papers), 'Environmental context and resources' (40.4%), 'Skills' (38.5%), and 'Social/professional role and identity' (32.7%). Four key implications were identified: Knowledge as a major barrier and enabler; Education to build capacity; Uncertainty about role of PCPs; and Additional needs beyond education alone.Discussion: While PCPs are optimistic about genomics, long standing barriers to delivery in primary care remain. Multifaceted, and evidence-based education strategies, including interactive components to change behaviour, will help to address barriers. Clarifying the role of PCPs, referral pathways, and collaboration with tertiary genetics services will further build capacity for genomics delivery in primary care.