By 2027, every NHS cancer doctor and nurse will need to understand genomic testing well enough to explain results to patients and guide them on sharing information with relatives—but most have no training in this area. This research tackles a looming gap: the NHS is moving genomic testing from specialist genetics clinics into routine cancer care, a process called mainstreaming. Without properly supporting oncology staff, patients may not receive appropriate treatments, and relatives may miss opportunities for early detection or prevention. The project uses a realist review—a method that asks not just whether a training approach works, but for whom, in what context, and why. If successful, the findings will shape how NHS England expands mainstreaming beyond cancer into other conditions like cardiac and neurological diseases. The long-term impacts include better staff confidence and retention, improved patient access to targeted treatments, and increased genetic referrals for at-risk relatives. This is applied health services research with direct implications for how the NHS delivers genomic medicine at scale.
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Research questions 1. What are the known/available approaches used to train oncology staff to engage with, communicate and act on genomic testing information, and who do they work for? 2. How are these staff currently supported to engage with, communicate and act on mainstreaming cancer genomic testing information and by whom? 3. How are these approaches assumed to work i.e. in what contexts, why and under what circumstances? 4. What intended and unintended outcomes do these approaches contribute to, (i.e. staff knowledge, skills and confidence, informed and supported patients, changes to patient management, uptake of genetic referral amongst relatives, professional development and practice, workload and job satisfaction)? 5. What are the critical gaps in the literature? Background: Genomic testing is changing healthcare globally, improving early detection of disease, enhancing prevention and therapies, speeding up diagnoses and reducing the effects of treatment (1). To maximise the benefits to the UK population, genomic testing is being integrated into routine healthcare (mainstreaming), with full implementation intended in 2027 (1). Effective mainstreaming relies on a major change in the way genomic testing is delivered, moving from genetic specialists to nurses and doctors in all areas. Health professionals with no prior training or experience in genomics are required to rapidly upskill. Mainstreaming will not succeed unless staff understand genomic testing and have the skills to explain the relevant information to patients and support them to share the results with relatives. Evidence regarding the implementation of mainstreaming is becoming available, mostly in oncology, making it feasible and timely to synthesise what works to support oncology staff in their engagement with genomic testing and their ability to communicate and act on genomic information. Mainstreaming genomics in oncology provides an exemplar which will be transferable to other conditions including cardiac and neurology as further evidence emerges. Aims and objectives: This research aims to identify what works to support oncology staff to engage with, communicate and act on mainstreaming genomic testing information, how it works, for which staff and under what circumstances. Methods: We propose to undertake a realist review with embedded interviews. Realist reviews seek to identify and articulate the embedded theory about how, when and for whom the intervention or programme may bring about a change or effect (2). This involves understanding how contextual factors affect the activation of mechanisms (i.e. changes in participant reasoning or behaviours) to produce various outcomes. Timelines for delivery: 24 months from Sept 2025 Anticipated impact and dissemination: We anticipate the outcome will inform plans to expand mainstreaming across NHS England. Long term anticipated impacts are (i) enhanced staff competence leading to improved job satisfaction and staff retention, (ii) improved patient access to appropriate treatment leading to better outcomes; and (iii) increased genetics referrals for relatives leading to early detection and prevention of disease. Together with PPI and stakeholder group members, we will disseminate our findings to genomics leaders, policymakers, clinicians, educators, patient organisations and academic audiences as they emerge via academic publications, presentations, webinars, plain English summaries, infographics and videos.
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