The three 'A's: Alert, Ask, Act

In the 'Overview' section we look at the role played by genetic factors in the development of disease or ill-health. In this section, we look at how you can apply this knowledge in your day-to-day work to give the best possible care to all patients. Let's start with a question.

What are the three 'A's?

The simplest way to ensure you take account of genetic factors in your work is to use the ‘three As’. Select each of the letters in the activity below to find out more.

Being 'alert'

There are many situations in which people disclose a key piece of information that could have relevance to their long-term health and wellbeing, or that of their family members. Sometimes this is in a formal interaction and often these critical 'clues' arise during informal discussion. There are a number of 'red flags' that you should look out for when discussing the patient's 'Past' (previous and family medical history), 'Present' (current medical history), or their 'Plans' for the future (family planning or pregnancy). Let's look at these three 'P's in more detail. Explore the activity below to find out more about the three 'P's.

'Asking' and 'acting'

Let's now turn our attention to the other two 'A's - Ask and Act. Try this quick quiz and check your responses with our expert's feedback then read the summary that follows.

It is not necessarily your responsibility, or even within your capacity or scope of practice to answer all of a patient's questions. It is important though to know who to refer them to when you don't have the answers. If you do find yourself discussing genetic issues with a patient, it is important to be aware of the following:

• Guilt – for many individuals the thought that they might somehow have ‘given’ a condition to someone in their family can lead to strong feelings of guilt.
• Understanding – discussing genetic conditions requires an understanding of probability and risk. It is worth remembering that many individuals may struggle with this and you will need to be particularly clear when you talk about probabilities (for example, a risk of 1 in 4 does not mean that a family with three healthy children will definitely have a sick fourth child).
• The patient’s concerns – a patient’s first thought on being given a diagnosis may not be of themselves. They may be more concerned about the implications for other family members.
• Cultural and religious issues - in some cultures there may be a stigma attached to giving birth to an 'imperfect' child, with issues of blame attached to the mother. There can also be strong religious beliefs associated with this, for instance a child being born with a genetic condition being 'the will of  God'.

If a patient decides to have genetic tests or screening, there are some specific ethical and privacy considerations that must be considered. This is because the test results may be relevant to other family members and not just the individual:

• Privacy and sharing of information - many individuals are happy for information about genetic conditions to be shared with other family members; some may decide they do not want this. It is important to discuss this issue before testing and to make individuals aware that information on family conditions may be shared between health professionals where it is in the best interests of care for anyone who may be affected.
• Issues of consent – some tests can give a prediction of future illness, perhaps in later adulthood. The prediction may be for a life-limiting condition for which there is no current cure. An adult may understand the implications of what such a test might tell them, but children or teenagers may not have the maturity to deal with this type of knowledge. Current consensus is that if a test will provide information that is of medical use now or in the near future it is appropriate for the test to be performed for a child or adolescent. Tests that are predictive of late-onset disease with no current treatment should only be performed when the individual has reached a point where they are mature enough to decide whether or not to be tested.