Journal of General Internal Medicine

, Volume 28, Issue 6, pp 817–824 | Cite as

Use of a Web-based Risk Appraisal Tool for Assessing Family History and Lifestyle Factors in Primary Care

  • Heather J. Baer
  • Louise I. Schneider
  • Graham A. Colditz
  • Hank Dart
  • Analisa Andry
  • Deborah H. Williams
  • E. John Orav
  • Jennifer S. Haas
  • George Getty
  • Elizabeth Whittemore
  • David W. Bates
Original Reserach

ABSTRACT

BACKGROUND

Primary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients.

OBJECTIVE

We evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.

DESIGN

Five primary care practices within an academic care network were assigned to the intervention or control group.

PARTICIPANTS

We included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010–2011.

INTERVENTION

Intervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening.

MAIN MEASURES

The main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening.

KEY RESULTS

Among eligible intervention patients, 2.0 % had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6 % of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening.

CONCLUSIONS

Use of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.

KEY WORDS

risk appraisal family history cancer primary care 

REFERENCES

  1. 1.
    Colditz GA, Samplin-Salgado M, Ryan CT, et al. Harvard report on cancer prevention, volume 5: fulfilling the potential for cancer prevention: policy approaches. Cancer Causes Control. 2002;13:199–212.PubMedCrossRefGoogle Scholar
  2. 2.
    Valdez R, Yoon PW, Qureshi N, Green RF, Khoury MJ. Family history in public health practice: a genomic tool for disease prevention and health promotion. Annu Rev Public Health. 2010;31:69–87. 1 p following.PubMedCrossRefGoogle Scholar
  3. 3.
    Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. Jama. 2004;291:2616–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Yoon PW, Scheuner MT, Peterson-Oehlke KL, Gwinn M, Faucett A, Khoury MJ. Can family history be used as a tool for public health and preventive medicine? Genet Med. 2002;4:304–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Claassen L, Henneman L, Janssens AC, et al. Using family history information to promote healthy lifestyles and prevent diseases; a discussion of the evidence. BMC Public Health. 2010;10:248.PubMedCrossRefGoogle Scholar
  6. 6.
    Sabatino SA, Habarta N, Baron RC, et al. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives. Am J Prev Med. 2008;35:S67–74.PubMedCrossRefGoogle Scholar
  7. 7.
    McDonald CJ. The barriers to electronic medical record systems and how to overcome them. Journal of the American Medical Informatics Association: JAMIA. 1997;4:213–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93:635–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Acheson LS, Wiesner GL, Zyzanski SJ, Goodwin MA, Stange KC. Family history-taking in community family practice: implications for genetic screening. Genet Med. 2000;2:180–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Murff HJ, Byrne D, Syngal S. Cancer risk assessment: quality and impact of the family history interview. Am J Prev Med. 2004;27:239–45.PubMedGoogle Scholar
  11. 11.
    Murff HJ, Greevy RA, Syngal S. The comprehensiveness of family cancer history assessments in primary care. Community Genet. 2007;10:174–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilson BJ, Qureshi N, Santaguida P, et al. Systematic review: family history in risk assessment for common diseases. Ann Intern Med. 2009;151:878–85.PubMedCrossRefGoogle Scholar
  13. 13.
    Yoon PW, Scheuner MT, Jorgensen C, Khoury MJ. Developing Family Healthware, a family history screening tool to prevent common chronic diseases. Prev Chronic Dis. 2009;6:A33.PubMedGoogle Scholar
  14. 14.
    Baghelai C, Nelkin VS, Miller TR. Health Risk Appraisals in Primary Care: Current Knowledge and Potential Applications to Improve Preventive Services and Chronic Care. Rockville, Maryland: Agency for Healthcare Research & Quality; 2009.Google Scholar
  15. 15.
    Poon EG, Wald J, Bates DW, Middleton B, Kuperman GJ, Gandhi TK. Supporting patient care beyond the clinical encounter: three informatics innovations from Partners health care. AMIA Annu Symp Proc 2003:1072.Google Scholar
  16. 16.
    Colditz GA, Atwood KA, Emmons K, et al. Harvard report on cancer prevention volume 4: Harvard Cancer Risk Index. Risk Index Working Group, Harvard Center for Cancer Prevention. Cancer Causes Control. 2000;11:477–88.PubMedCrossRefGoogle Scholar
  17. 17.
    Emmons KM, Wong M, Puleo E, Weinstein N, Fletcher R, Colditz G. Tailored computer-based cancer risk communication: correcting colorectal cancer risk perception. J Health Commun. 2004;9:127–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim DJ, Rockhill B, Colditz GA. Validation of the Harvard Cancer Risk Index: a prediction tool for individual cancer risk. Journal of clinical epidemiology. 2004;57:332–40.PubMedCrossRefGoogle Scholar
  19. 19.
    Rifas-Shiman SL, Willett WC, Lobb R, Kotch J, Dart C, Gillman MW. PrimeScreen, a brief dietary screening tool: reproducibility and comparability with both a longer food frequency questionnaire and biomarkers. Public Health Nutr. 2001;4:249–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Qureshi N, Wilson B, Santaguida P, et al. Collection and use of cancer family history in primary care. Evid Rep Technol Assess (Full Rep) 2007:1-84.Google Scholar
  21. 21.
    Denney-Wilson E, Fanaian M, Wan Q, Vagholkar S, Schutze H, Mark M. Lifestyle risk factors in general practice - routine assessment and management. Aust Fam Physician. 2010;39:950–3.PubMedGoogle Scholar
  22. 22.
    Stange KC, Flocke SA, Goodwin MA, Kelly RB, Zyzanski SJ. Direct observation of rates of preventive service delivery in community family practice. Prev Med. 2000;31:167–76.PubMedCrossRefGoogle Scholar
  23. 23.
    O'Neill SM, Rubinstein WS, Wang C, et al. Familial risk for common diseases in primary care: the Family Healthware Impact Trial. Am J Prev Med. 2009;36:506–14.PubMedCrossRefGoogle Scholar
  24. 24.
    Ruffin MT, Nease DE Jr, Sen A, et al. Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial. Ann Fam Med. 2011;9:3–11.PubMedCrossRefGoogle Scholar
  25. 25.
    Emery J. The GRAIDS Trial: the development and evaluation of computer decision support for cancer genetic risk assessment in primary care. Ann Hum Biol. 2005;32:218–27.PubMedCrossRefGoogle Scholar
  26. 26.
    Emery J, Morris H, Goodchild R, et al. The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care. Br J Cancer. 2007;97:486–93.PubMedCrossRefGoogle Scholar
  27. 27.
    Acheson LS, Zyzanski SJ, Stange KC, Deptowicz A, Wiesner GL. Validation of a self-administered, computerized tool for collecting and displaying the family history of cancer. J Clin Oncol. 2006;24:5395–402.PubMedCrossRefGoogle Scholar
  28. 28.
    Jones JL, Hughes KS, Kopans DB, et al. Evaluation of hereditary risk in a mammography population. Clin Breast Cancer. 2005;6:38–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Skinner CS, Rawl SM, Moser BK, et al. Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy. J Gen Intern Med. 2005;20:360–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Sweet KM, Bradley TL, Westman JA. Identification and referral of families at high risk for cancer susceptibility. J Clin Oncol. 2002;20:528–37.PubMedCrossRefGoogle Scholar
  31. 31.
    My Family Health Portrait. A tool from the Surgeon General. (Accessed January 4, 2013, at https://familyhistory.hhs.gov/fhh-web/.)

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Heather J. Baer
    • 1
    • 2
    • 3
  • Louise I. Schneider
    • 1
    • 2
  • Graham A. Colditz
    • 4
  • Hank Dart
    • 4
  • Analisa Andry
    • 1
  • Deborah H. Williams
    • 1
  • E. John Orav
    • 1
    • 2
    • 5
  • Jennifer S. Haas
    • 1
    • 2
    • 6
  • George Getty
    • 7
  • Elizabeth Whittemore
    • 1
  • David W. Bates
    • 1
    • 2
    • 7
    • 8
  1. 1.Division of General Internal Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Alvin J. Siteman Cancer Center and Department of SurgeryWashington University School of MedicineSt. LouisUSA
  5. 5.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  6. 6.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  7. 7.Partners HealthCareBostonUSA
  8. 8.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA

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