Clinical utility of family history for cancer screening and referral in primary care: A report from the Family Healthware Impact Trial.

Rubinstein WS, Acheson LS, Oʼneill SM, Ruffin MT 4th, Wang C, Beaumont JL, Rothrock N; for the Family Healthware Impact Trial (FHITr) Group.

Source

From the 1Department of Medicine, Division of Genetics, NorthShore University HealthSystem (previously named Evanston Northwestern Healthcare), Evanston, Illinois; 2Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois; 3Department of Family Medicine, Research Division, Case Western Reserve University; 4University Hospitals Case Medical Center; 5Case Comprehensive Cancer Center, Cleveland, Ohio; 6Department of Medicine, Northwestern University, Chicago, Illinois; 7Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; and 8Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts; and 9Department of Medical and Social Sciences, Northwestern University, Chicago, Illinois.

Abstract

PURPOSE:

To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change.

METHODS:

We conducted a randomized clinical trial in primary care patients aged 35-65 years using Family Healthware, a self-administered, internet-based tool that collects family history for six common diseases including breast cancer, colon cancer, and ovarian cancer, stratifies risk into three tiers, and provides tailored prevention messages. Cancer screening adherence and consultation were measured at baseline and 6-month follow-up.

RESULTS:

Of 3283 participants, 34% were at strong or moderate risk of at least one of the cancers. Family Healthware identified additional participants for whom earlier screening (colon cancer, 4.4%; breast cancer, women ages: 35-39 years, 9%) or genetic assessment (colon cancer, 2.5%; breast cancer, 10%; and ovarian cancer, 4%) may be indicated. Fewer than half were already adherent with risk-based screening. Screening adherence improved for all risk categories with no difference between intervention and control groups. Consultation with specialists did not differ between groups.

CONCLUSION:

Family Healthware identified patients for intensified cancer prevention. Engagement of clinicians and patients, integration with clinical decision support, and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment.