Components of family history associated with women's disease perceptions for cancer: A report from the Family Healthware™ Impact Trial
| Autor: | Louise S. Acheson, Wendy S. Rubinstein, Robert Gramling, Erin J. Starzyk, Catharine Wang, Suzanne M. O'Neill, James M. Galliher, Mack T. Ruffin, Jennifer L. Beaumont, Nan E. Rothrock |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Adult
medicine.medical_specialty Health Knowledge Attitudes Practice Genetic counseling Disease Article Risk Factors Neoplasms Cancer screening medicine Health belief model Cluster Analysis Humans Medical history Family history Psychiatry Genetics (clinical) Genetic testing Aged Family Health medicine.diagnostic_test business.industry Middle Aged Family medicine Female Perception business Risk assessment Attitude to Health |
| Popis: | Family medical history is a time-honored tool used by clinicians to assess patients' risk of developing common, chronic diseases and less common genetic disorders. An analysis of family history can inform a differential diagnosis, guide early detection and prevention strategies, and provide clinicians with a means to develop rapport with patients. In a study assessing laypeople's attitudes about hypothetical disease risk, a positive family history was more concerning than a positive genetic test result.1 Although people make connections between their own health and their relatives' medical experiences, qualitative studies have shown that patients' and clinicians' interpretations of family history often diverge.2–4 The challenge to motivate patients to adopt and maintain healthy behaviors and to obtain recommended screening could be assisted by a better understanding of patients' disease perceptions and how these correlate with key elements of their family history. In recent years, there has been a strong interest in the development of automated tools to efficiently gather family history and provide an objective risk assessment.5–9 The rationale for systematic familial risk assessment includes tailoring of screening recommendations, promotion of healthy behaviors (diet, exercise, etc.), and referral for more comprehensive evaluation, potentially including genetic counseling and genetic testing. One such tool, Family Healthware™, is a Web-based program developed by the Centers for Disease Control and Prevention (CDC) that collects medical history about first- and second-degree relatives, assesses and stratifies into three tiers familial risk for coronary heart disease, stroke, diabetes, breast cancer (BC), colon cancer (CC), and ovarian cancer (OC), and provides tailored recommendations for screening tests and lifestyle changes.5 The CDC selected three academic centers to evaluate the clinical utility of Family Healthware in primary care settings through the Family Healthware Impact Trial (FHITr).10 Perceptions of risk, severity, worry, and control are core components of theories that explain health behavior including the Health Belief Model,11,12 the Theory of Planned Behavior,13 the Common-Sense Model,14 and Extended Parallel Process Model.15 Therefore, we measured these perceptions in the FHITr trial.10 Individuals with a family history of cancer have a greater likelihood of undergoing cancer screening and have stronger intentions to undergo future screening.16,17 But, although risk perception18,19 and worry20 and having a positive family history are predictive of BC and CC screening adherence, these characteristics do not correlate tightly, suggesting that additional factors are crucially important as well. We have shown that, for example, among a large primary care population of FHITr study participants, the familial risk of common diseases was related to their perceived risk and worry about these diseases, before any intervention.21 However, the high rates of optimistic bias22,23 that we observed also may represent some of the factors contributing to nonideal rates of screening adherence. The specific family history elements underlying health behaviors are mostly unexamined except for BC, where having affected first-degree relatives and the number of affected relatives correlate with a greater likelihood of screening24,25 and uptake of prophylactic mastectomy.26 The current analyses examine that which particular elements of participants' detailed family histories of BC, OC, and CC are related to their perceptions about their own susceptibility, severity, worry, and control of these common cancers. Although most studies examine perceptions for single diseases, patients often must gauge perceptions of multiple diseases. Here, we measure health beliefs simultaneously for three types of cancer to better understand variability of beliefs based on components of family history and family structure. |
| Databáze: | OpenAIRE |
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