Family Practice Advance Access originally published online on August 28, 2007
Family Practice 2007 24(5):435-442; doi:10.1093/fampra/cmm037
Assessing family history of heart disease in primary care consultations: a qualitative study
a ESRC Centre for Genomics in Society, Byrne House, St German's Road, University of Exeter, Exeter EX4 4PJ
b Peninsula Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter EX1 2LU
c Graduate Medical School, University of Nottingham, Derby City General Hospital Uttoxeter Road, Derby DE22 3DT
d Centre for Cardiovascular Genetics, Department of Medicine, British Heart Foundation Laboratories, Rayne Building, Royal Free and University College Medical School, 5 University Street, London WC1E 6JF, UK
Correspondence to Dr Paula M Saukko, ESRC Centre for Genomics in Society, Byrne House, St German's Road, University of Exeter, Exeter EX4 4PJ, UK; Email: p.saukko{at}exeter.ac.uk
Received 23 November 2006; Revised 9 May 2007; Accepted 16 June 2007.
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Abstract |
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Background. Current primary prevention guidelines recommend the assessment of family history of coronary heart disease (CHD) to identify at-risk individuals.
Objective. To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care.
Methods. A qualitative study. Patients completed a validated family history questionnaire. Consultations with clinicians were video recorded, and semi-structured interviews conducted with patients after consultation. The participants were 21 primary care patients and seven primary care clinicians (two practice nurses, five GPs). Four practices in South West England.
Results. Patients and clinicians usually agreed about the patient's level of risk and how to reduce it. Patients were mostly satisfied with their consultations and having their family history assessed. However, three issues were identified from the consultations which contributed to concerns and unanswered questions for patients. Problems arose when there were few modifiable risk factors to address. Firstly, patients' explanations of their family history were not explored in the consultation. Secondly, the relationship between the patient's family history and their other risk factors, such as smoking or cholesterol, was rarely discussed. Thirdly, clinicians did not explain the integration of family history into the patient's overall cardiovascular disease risk.
Conclusions. Clinicians appeared to lack a rhetoric to discuss family history, in terms of capturing both genetic and environmental factors and its relation to other risk factors. This created uncertainties for patients and carries potential clinical and social implications. There is a need for better guidance for primary care clinicians about family history assessment.
Keywords. Communication, coronary heart disease, family history, primary care.
Hall R, Saukko PM, Evans PH, Qureshi N and Humphries SE. Assessing family history of heart disease in primary care consultations: a qualitative study. Family Practice 2007; 24: 435–442.