Clinicians believed that they were the most appropriate group, while geneticists and experts with a bioethical background thought that results should be disclosed by a multidisciplinary team. This team should consist of not only clinicians but also other professionals, such as geneticists and clinicians specialised in the relevant condition (e.g. oncologist if a cancer susceptibility gene had been discovered).

At the same time, most of the experts Cell Cycle inhibitor questioned the appropriateness of clinicians not specialised in genetics dealing with genetic tests and the results, especially when NGS is used. They were of the opinion that non-specialist clinicians lacked the expertise to explain the procedures and to provide pre- and post-testing counselling. The lack of a recognised specialty of “clinical geneticist” made things even harder. To understand that, here we are acting as genetic counsellors because compound screening assay we don’t have genetic counsellors and doctors don’t know what to do. They are asking for our help and sometimes even we don’t know what to do (Participant 05). Not to mention that we don’t even have a specialty recognised! (Participant 02) Which results should be returned? Most experts mentioned the concept

of “patient autonomy” and understood this as each patient’s individual right to choose whether or not to be told about IFs, although their ideas about the best way to achieve this varied. We need to make sure that they are informed well enough and that they are deciding autonomously.

We should give them all the information we can and let them decide by themselves (Participant 03). Whoever is doing the genetic counselling should provide all the available information. They should let them know that IFs could be discovered. And then it is on the individual’s responsibility these to ask his doctor if they indeed discovered something. This way we would be sure that the individual actually wants to learn the findings. If it is the doctor that asks then that is not exactly autonomous! They need to actively participate! (Participant 01) However, it seems current practice is not always guided by this principle. Clinicians admitted they do occasionally adopt a more paternalistic approach and try to act in what they think is their patient’s best interest, even if this means making some preliminary decisions by themselves. Even if the patient has asked for all results we won’t give him everything. We will definitely give him clinically valid and clinically actionable ones, or results that concern serious of life-threatening conditions but about the rest of them … I don’t know. We will discuss about it and according to what we will decide we will let him know (Participant 06). We won’t give him everything. We will discuss it and we will decide what he needs to know (Participant 08).