Providing patient education: impact on quantity and quality of family health history collection
Background: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. Objective: Evaluate the influence of patient education on quantity and quality of FHH entered into a primary care-based software program, and impact on the program’s cancer risk management recommendations. Design: Two primary care practices within a larger type II hybrid implementation-effectiveness controlled clinical trial. Participants: English speaking non-adopted patients with a well visit appointment December 2012–March 2013. Interventions: One to two weeks prior to their well visit appointment, participants entered their FHH into the program. Participants were then provided educational materials describing key FHH components. They were instructed to use the interval to collect additional FHH information. Patients then returned for their scheduled appointment, and updated their FHH with any new information. Main Measures: Percentage per pedigree of relatives meeting individual quality criteria. Changes made after patient education and changes to recommendations for surveillance, chemoprevention or genetic counseling referral. Key Results: Post patient education, pedigrees exhibited a greater percentage (per pedigree) of: deceased relatives with age at death (84 vs. 81 % p = 0.02), deceased relatives with cause of death (91 vs. 87 % p = 0.02), relatives with a named health condition (45 vs. 42 % p = 0.002), and a greater percentage of relatives with high quality records (91 vs. 89 % p = 0.02). Of 43 participants with pedigree changes that could trigger changes in risk stratified prevention recommendations, 12 participants (28 %) received such changes. Conclusions: Patient education improves FHH collection and subsequent risk stratification utilized in providing actionable evidence-based care recommendations for cancer risk management.
KeywordsFamily history Patient education Risk assessment Clinical decision support
The authors received funds from Department of Defense.
Conflict of interest
- 5.Acheson L (2010) Family history and genetic testing for cancer risk. American family physician 81(8):934–938; author reply 934–938Google Scholar
- 6.Qureshi N, Armstrong S, Dhiman P, Saukko P, Middlemass J, Evans PH, Kai J (2012) Effect of adding systematic family history enquiry to cardiovascular disease risk assessment in primary care: a matched-pair, cluster randomized trial. Ann Intern Med 156(4):253–262. doi: 10.7326/0003-4819-156-4-201202210-00002 PubMedCrossRefGoogle Scholar
- 8.Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin TR, Pickhardt P, Rex DK, Thorson A, Winawer SJ, American Cancer Society Colorectal Cancer Advisory G, Force USM-ST, American College of Radiology Colon Cancer C (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58(3):130–160. doi: 10.3322/CA 2007.0018PubMedCrossRefGoogle Scholar
- 10.Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC Jr, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, American College of Cardiology Foundation/American Heart Association Task Force on Practice G (2010) 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 122(25):e584–e636. doi: 10.1161/CIR.0b013e3182051b4c PubMedCrossRefGoogle Scholar
- 15.Berg AO, Baird MA, Botkin JR, Driscoll DA, Fishman PA, Guarino PD, Hiatt RA, Jarvik GP, Millon-Underwood S, Morgan TM, Mulvihill JJ, Pollin TI, Schimmel SR, Stefanek ME, Vollmer WM, Williams JK (2009) National Institutes of Health State-of-the-Science Conference Statement: family history and improving health. Ann Intern Med 151:878–885. doi: 10.1059/0003-4819-151-12-200912150-00165 CrossRefGoogle Scholar
- 22.Qureshi N, Wilson B, Santaguida P, Little J, Carroll J, Allanson J, Raina P (2009) Family history and improving health. Evid Rep Technol Assess (Full Rep) 186:1–135Google Scholar
- 23.Feero WG, Bigley MB, Brinner KM (2008) New standards and enhanced utility for family health history information in the electronic health record: an update from the American Health Information Community’s Family Health History Multi-Stakeholder Workgroup. J Am Med Inform Assoc 15(6):723–728. doi: 10.1197/jamia.M2793 PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Green MJ, Peterson SK, Baker MW, Friedman LC, Harper GR, Rubinstein WS, Peters JA, Mauger DT (2005) Use of an educational computer program before genetic counseling for breast cancer susceptibility: effects on duration and content of counseling sessions. Genet Med 7(4):221–229. doi:http://www.ncbi.nlm.nih.gov/pubmed/15834239 PubMedCentralPubMedCrossRefGoogle Scholar
- 32.Orlando LA, Hauser ER, Christianson C, Powell KP, Buchanan AH, Chesnut B, Agbaje AB, Henrich VC, Ginsburg G (2011) Protocol for implementation of family health history collection and decision support into primary care using a computerized family health history system. BMC Health Serv Res 11:264. doi: 10.1186/1472-6963-11-264 PubMedCentralPubMedCrossRefGoogle Scholar
- 33.R Core Team (2013) R: a language and environment for statistical computing. R foundation for statistical computing. http://www.R-project.org. Accessed 2013