Family History Intervention Stirs Communication.
A web-based family health history intervention was useful in prompting patients to talk with their relatives about health conditions in their families and to collect their family histories—indicating that such assessments may influence patients’ understanding of risks, which could motivate subsequent behavior, a study led by a School of Public Health researcher found.
The study, published online in the journal Preventive Medicine, found that patients who had not talked to family members about their family histories were more likely to communicate with relatives after they received information about familial risk for heart disease, diabetes, and other common chronic conditions. Yet they were not more likely to discuss their family histories with health care providers, researchers found.
Sharing information on risk with family members and health clinicians is considered a positive step in patients taking the initiative to improve their health.
The study gauged communication with relatives and providers among patients who were given a web-based health history tool—Family HealthwareTM, developed by the Centers for Disease Control and Prevention—as compared to those who weren’t. The tool assesses familial risk for six chronic conditions and provides personalized messages based on risk.
The intervention did not have a significant effect on family communication among patients who had engaged in recent discussions about family history with their relatives, the study found. But it did prompt other patients to start communicating, especially those at an increased risk for multiple diseases.
Catharine Wang, associate professor of community health sciences at SPH and lead author of the study, said the findings suggest that “new efforts are needed to encourage greater sharing of family history information,” particularly with health care providers.
“A person’s family health history remains one of the strongest predictors of his or her risk for many diseases,” Wang said. “Tools like Family HealthwareTM help to identify disease risks based on this history. If these tools are used to stimulate discussions with family members and health care providers, they not only would lead to better awareness of disease risks, but also could identify and flag important conditions for a doctor to pay closer attention to.”
The study recruited patients from 41 primary care practices affiliated with three academic sites. Risk based on family history was calculated using the Family HealthwareTM tool, which determines familial risk based on self-reported health history for the patient and his or her first- and second-degree relatives. Participants were asked, initially, if they had talked with family members or providers about their health history, and then asked again at a six-month follow-up.
The researchers found evidence of a so-called dose effect, in that patients who were found to be at “elevated familial risk” for a greater number of diseases were more likely to talk with family members following the receipt of risk information. Women also were more likely to talk to relatives and to collect family information about risk than men.
“To date, few studies have examined whether interventions to increase family history awareness and documentation increase the extent to which this information is discussed within families or shared with health care providers,” the research team wrote. Encouraging such discussions could “motivate lifestyle behavior change . . . towards improved prevention and care.”
The study notes that national efforts to promote awareness of the importance of family history “often emphasize the importance of communication and the sharing of this information with family members and health care providers.”
The intervention’s lack of effect on communication with health care providers may reflect how often patients saw a clinician in the six months after the trial, whether they received assessments that showed little or no risk, or general “uncertainty about how to communicate with their provider,” the authors said.
They said that prior research has indicated that some patients might be unsure how their family members or doctors would react to discussions about family history, suggesting that “there are barriers in communication that may need to be addressed to facilitate greater sharing of family history information.”
In addition to Wang, the research team included members from the National Institutes of Health, Northwestern University Feinberg School of Medicine , University of Michigan, and Case Western Reserve University.
The Family HealthwareTM Impact Trial was supported through cooperative agreements between the CDC and the Association for Prevention Teaching and Research and the American Association of Medical Colleges. Wang’s work is supported by the National Cancer Institute and a Peter T. Paul career development professorship from Boston University.
Submitted by: Lisa Chedekel