Family history and perceptions about risk and prevention for chronic diseases in primary care: A report from the Family Healthware™ Impact Trial

Abstract

Purpose To determine whether family medical history as a risk factor for six common diseases is related to patients' perceptions of risk, worry, and control over getting these diseases. Methods We used data from the cluster-randomized, controlled Family Healthware™ Impact Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention group participants used Family Healthware™ to record family medical history; this web-based tool stratified familial disease risks. Multivariate and multilevel regression analyses measured the association between familial risk and patient perceptions for each disease, controlling for personal health and demographics. Results For the 2330 participants who used Family Healthware™ immediately after providing baseline data, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived risk ranged from 0.35 standard deviation for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived control over developing diseases. Risk perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below. Conclusions Participants' ratings of their risk for developing common diseases, before feedback on familial risk, parallels but is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to prevent the disease.

Clinical utility of a Web-enabled risk-assessment and clinical decision support program

“…This is not surprising given the well-documented barriers to collecting and synthesizing family health history. 3,20,[30][31][32] Overestimation was also evident, with 17 average-risk patients receiving increased-risk care. It is reassuring that, given the high number of average-risk patients, this percentage was quite small; however, as more conditions are included in risk assessments, the baseline proportion is likely to increase.…”

“You don’t have to keep everything on paper”: African American women’s use of family health history tools

“…Most research on family history has studied highly selected populations, often those who are white and of high socioeconomic status (O'Neill et al 2009;Acheson et al 2010;Wideroff et al 2010;Cohn et al 2010). The present study extends current research by focusing on members of one minority population in the United States.…”

“…Despite persistent health disparities between Whites and many other racial and ethnic groups in the USA (American Cancer Society 2011), most research on collection of FHH information and use of FHH tools has included mainly white participants (O'Neill et al 2009;Acheson et al 2010;Wideroff et al 2010;Cohn et al 2010). One study of African Americans participating in a FHH and genetics intervention suggests that pledging to collect FHH information might be an effective strategy for promoting the collection of such information in this population (Butty et al 2012).…”

The family history: the first genetic test, and still useful after all those years?

“…Although the detailed family history correlated with risk perceptions, people had an optimistic bias. 54 Only having a mother with early onset breast or ovarian cancer was appropriately associated with a perceived risk of breast cancer. 55 Having a positive family history of colon cancer or breast cancer results in higher uptake of routine screening, 56 but whether this is due to the primary care physician or the patient being motivated is unclear.…”