Journal of Genetic Counseling

, Volume 24, Issue 1, pp 179–188 | Cite as

Use of a Patient-Entered Family Health History Tool with Decision Support in Primary Care: Impact of Identification of Increased Risk Patients on Genetic Counseling Attendance

  • Adam H. BuchananEmail author
  • Carol A. Christianson
  • Tiffany Himmel
  • Karen P. Powell
  • Astrid Agbaje
  • Geoffrey S. Ginsburg
  • Vincent C. Henrich
  • Lori A. Orlando
Original Research


Several barriers inhibit collection and use of detailed family health history (FHH) in primary care. MeTree, a computer-based FHH intake and risk assessment tool with clinical decision support, was developed to overcome these barriers. Here, we describe the impact of MeTree on genetic counseling (GC) referrals and attendance. Non-adopted, English speaking adults scheduled for a well-visit in two community-based primary-care clinics were invited to participate in an Implementation-Effectiveness study of MeTree. Participants’ demographic characteristics and beliefs were assessed at baseline. Immediately after an appointment with a patient for whom GC was recommended, clinicians indicated whether they referred the patient and, if not, why. The study genetic counselor kept a database of patients with a GC recommendation and contacted those with a referral. Of 542 patients completing MeTree, 156 (29 %) received a GC recommendation. Of these, 46 % (n = 72) were referred and 21 % (n = 33) underwent counseling. Patient preferences, additional clinical information unavailable to MeTree, and an incomplete clinician evaluation of the FHH accounted for the 85 patients clinicians chose not to refer. Although MeTree identified a significant proportion of patients for whom GC was recommended, persistent barriers indicate the need for improved referral processes and patient and physician education about the benefits of GC.


Personalized medicine Family history Primary care providers Referral Genetic counseling 



The entire Genomedical Connection consortium contributed to this study. Other members include Lorene Eaton (University of North Carolina at Greensboro); Astrid Agbaje, MA, Carla Williams, BSW, MS, and Lisa Wilkerson (Cone Health System).

Conflict of Interest

Mr. Buchanan, Ms. Christianson, Ms. Himmel, Ms. Powell, Ms. Agbaje, and Drs. Ginsburg, Henrich, and Orlando declare that they have no conflict of interest. Funding was provided by The United States Department of the Army (W81XWH-05-1-0383), which had no active role in this study.

Human Studies and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Animal Studies

No animal studies were carried out by the authors for this article.


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Copyright information

© National Society of Genetic Counselors, Inc. 2014

Authors and Affiliations

  • Adam H. Buchanan
    • 1
    Email author
  • Carol A. Christianson
    • 2
  • Tiffany Himmel
    • 3
  • Karen P. Powell
    • 2
  • Astrid Agbaje
    • 4
  • Geoffrey S. Ginsburg
    • 3
  • Vincent C. Henrich
    • 2
  • Lori A. Orlando
    • 5
  1. 1.Duke Cancer Institute, Duke UniversityDurhamUSA
  2. 2.The Center for Biotechnology, Genomics and Health ResearchThe University of North Carolina at GreensboroGreensboroUSA
  3. 3.Duke Institute for Genome Sciences & PolicyDuke UniversityDurhamUSA
  4. 4.Moses Cone Health SystemGreensboroUSA
  5. 5.Department of MedicineDuke UniversityDurhamUSA

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