Your history may define your future: Tell your doctor

"Primary care clinicians can play a critical role in documenting a patient's family history and assessing the patient's risk factors for diseases like cancer," explained Heather Baer, ScD, an associate epidemiologist and assistant professor in the Division of General Medicine and Primary Care at BWH. "However, most clinicians see a large number of patients, have limited time during patient visits and may lack adequate systems for collecting and synthesizing this information."

The research team, lead by Baer, set out to evaluate the feasibility and effectiveness of using a web-based risk appraisal tool in a primary care setting. Researchers asked patients who had new patient visits or annual exams, throughout three primary care practices, to fill out the web-based risk appraisal tool on a laptop computer in the waiting room immediately before their visit. Two other primary care practices, where patients did not use the tool, were used for comparison.

A total of 996 patients filled out the tool while waiting for their appointment. The tool asked patients about their family history of cancer as well as lifestyle factors such as diet, physical activity and smoking. At the end of the questionnaire, patients received a report summarizing their risk of cancer, heart disease, diabetes and stroke. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted by the clinician, it went into coded fields and could trigger reminders for the clinician about colon and breast cancer screening. The researchers measured whether or not new documentation of a positive of family history of cancer was added to the EHR.

"We found that 10.6 percent of patients who used the tool had new information on family history of cancer entered in the EHR within 30 days after their visit, compared to less than one percent of control patients," explained Baer. "This type of risk assessment tool may be useful for collecting information on family history and lifestyle factors and may also help increase communication between physicians and patients about their risk."

One of the limitations of the study was that only a small percentage of eligible patients filled out the tool because of time constraints before their visit. Also, some of the family history information that patients filled in using the tool was not accepted into the EHR by their clinician. Researchers say further research is needed to determine how risk appraisal tools can be integrated with workflow at primary care practices and how they affect screening and health behaviors among patients.

This research is supported by grants from the CRICO/Risk Management Foundation of the Harvard Medical Institutions and from the National Human Genome Research Institute (1RC1HG005331). Dr. Baer is supported by a Mentored Research Scientist Career Development Award from the Agency for Healthcare Research and Quality (K01HS019789)..