Translations of risk: decision making in a cancer genetics service

This paper reports on the routine decision making practices of health professionals working within a genetics service. Specifically the paper focuses on professionals' assessments of whether patients are at increased risk of inheriting a gene that predisposes the individual to developing cancer. By analysing professionals' talk and actions whilst assessing risk, the paper develops an understanding of both routine and complex decision making. Whilst some decisions were unproblematic, there were a number of situations in which geneticists appear to challenge the decision rules. Such situations occur when faced with a borderline case, an interesting case, when the patient appears particularly anxious or when the rules themselves are judged to be inadequate. Whilst decision support technologies are able to assist clinical decision making they are not relied upon by geneticists above and beyond their own knowledge. Thus, when knowledge is uncertain the decisions that clinicians make are not a consequence of the standard application of scientific protocols but are locally determined according to experience, circumstance and case. This suggests that the transfer of decision support technologies to general practice or to the general public are unlikely to be effective, given the importance of clinical experience to the risk assessment process.