Theoretical Framework for Disease Risk Based on Family History

Genet Med. Writer manuscript; available in PMC 2014 May 28.

Published in final edited form as:

PMCID: PMC4037165

NIHMSID: NIHMS215977

Family unit history and perceptions about risk and prevention for chronic diseases in main intendance: A report from the Family Healthware™ Impact Trial

Louise S. Acheson, MS, Medico,^{1, 2, 3} Catharine Wang, MSc, PhD,^iv Stephen J. Zyzanski, PhD,^{1, 3} Audrey Lynn, PhD,^one Mack T. Ruffin, IV, MD, MPH,⁵ Robert Gramling, MD, DSc,⁶ Wendy S. Rubinstein, Dr., PhD,^{7, 8} Suzanne Thou. O'Neill, MS, PhD,^{vii, ix} Donald East. Nease, Jr., MD,⁵ and for the Family Healthware™ Touch on Trial (FHITr) Group

Louise S. Acheson

¹Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio

²Family Medicine Research Division and Department of Reproductive Biology, Academy Hospitals Case Medical Centre, Cleveland, Ohio

³Program in Cancer Prevention and Control, Case Comprehensive Cancer Eye, Cleveland, Ohio

Catharine Wang

⁴Department of Customs Health Sciences, Boston University School of Public Health, Boston, Massachusetts

Stephen J. Zyzanski

¹Department of Family Medicine, Case Western Reserve Academy, Cleveland, Ohio

³Programme in Cancer Prevention and Control, Example Comprehensive Cancer Center, Cleveland, Ohio

Audrey Lynn

^aneSection of Family Medicine, Example Western Reserve University, Cleveland, Ohio

Mack T. Ruffin, IV

^vSection of Family Medicine, University of Michigan, Ann Arbor, Michigan

Robert Gramling

⁶Departments of Family unit Medicine and Customs & Preventive Medicine, University of Rochester, Rochester, New York

Wendy Southward. Rubinstein

^viiDepartment of Medicine, Center for Medical Genetics, North-Shore University HealthSystem (previously named Evanston Northwestern Healthcare), Evanston, Illinois

⁸Department of Medicine, Academy of Chicago Pritzker School of Medicine, Chicago, Illinois

Suzanne K. O'Neill

⁷Section of Medicine, Centre for Medical Genetics, North-Shore University HealthSystem (previously named Evanston Northwestern Healthcare), Evanston, Illinois

⁹Division of Full general Medicine and Heart for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Donald Due east. Nease, Jr.

⁵Department of Family Medicine, University of Michigan, Ann Arbor, Michigan

Abstract

Purpose

To determine whether family unit medical history as a risk cistron for six common diseases is related to patients' perceptions of risk, worry, and command over getting these diseases.

Methods

We used data from the cluster-randomized, controlled Family Healthware™ Touch on Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention grouping participants used Family Healthware™ to tape family medical history; this web-based tool stratified familial illness risks. Multivariate and multilevel regression analyses measured the clan between familial adventure and patient perceptions for each disease, controlling for personal health and demographics.

Results

For the 2330 participants who used Family unit Healthware™ immediately after providing baseline information, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived hazard ranged from 0.35 standard departure for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived command over developing diseases. Hazard perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below.

Conclusions

Participants' ratings of their risk for developing common diseases, earlier feedback on familial risk, parallels just is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to foreclose the illness.

Keywords: family unit history, take a chance perception, worry, perceived control, primary intendance, family medicine, internal medicine, obstetrics and gynecology, prevention, familial risk assessment, informatics, coronary heart disease, stroke, diabetes, colon cancer, breast cancer, ovarian cancer

Family unit history is an important take a chance cistron for many common diseases including breast (BC), ovarian (OC), and colon cancers (CC), diabetes (DM), coronary heart disease (CHD), and stroke (ST). Although taking a brief family history is a routine part of medical intendance, particularly for new patients, systematic, more detailed family history assessment has been difficult to implement in primary care.^1–five Contempo development of family history tools that tin be cocky-administered and computer assisted has opened the possibility of widespread familial chance assessment for mutual diseases and personalized prevention plans based on familial risk stratification.^iv,6,7 Withal, an added claiming in investigating the health effects of using such tools is to account for the ways in which people'due south lifelong sensation of their family history has affected their health beliefs and behaviors earlier formal family unit history assessment.^viii Similarly, improved understanding of health behavior related to family medical history will exist needed when evaluating the utility of predictive, multiplex genetic testing for common diseases.^ix

People's interpretation of their ain family history of multi-factorial diseases such as cardiovascular disease, diabetes, or cancer is circuitous; yet, it may influence their perceived susceptibility to the disease and actions taken to prevent it.^10,11 In many theories of health behavior, run a risk perceptions, worry, and perceived control (ability to take action to prevent disease) are important motivators of preventive behaviors.^12–15 However, it has been hypothesized that inherited take chances in particular may sometimes be perceived as unavoidable, leading to fatalism.¹⁶ In other cases, people adduce various reasons why they would non be susceptible to diseases that run in their families.¹¹ Therefore, when investigating the furnishings of family history cess on disease prevention, it is of import to understand the human relationship of family medical history to people's perceptions of their own adventure of various diseases and their ability to accept actions to reduce the risk. Studies of these perceptions have often been limited by because single diseases and have often enrolled people from high adventure, referred groups. This article includes quantitative measures of perceived risk, worry, and command, compared with family unit history for half dozen common diseases, in a large sample of primary care patients.

Methods

Overview of the Family Healthware™ Touch on Trial

The Usa Centers for Disease Control and Prevention (CDC) sponsored development and evaluation of Family Healthware™, a cocky-administered, spider web-based questionnaire to collect and display family medical history, categorize familial take a chance, and deliver tailored prevention messages, prioritized according to the familial risk of vi common diseases.¹⁷ Similar to the US Surgeon Full general's family unit history tool,^eighteen the website prompts users to tape family unit history for each first and 2nd degree relative. Take a chance algorithms and family unit history-tailored prevention messages were added and tested, as previously described.¹⁷

In 2005–2007, the Family unit Healthware™ Impact Trial (FHITr) group (CDC Office of Genomics and Public Health, in a cooperative understanding with investigators at Evanston Northwestern Health care [E], University of Michigan [Yard], Instance Western Reserve Academy [C], and American University of Family Physicians' National Research Network [NRN]) conducted the FHITr, a cluster-randomized evaluation of Family Healthware™ among patients aged 35–65 years in primary care practices.¹⁹ Participants from control group practices completed a baseline questionnaire and received cursory, generic prevention messages. Participants in intervention group practices completed the same baseline questionnaire, followed by Family unit Healthware™, which delivered personalized familial hazard and prevention letters. Participants were encouraged to review the information with a clinician. Both groups were contacted vi months later to consummate a follow-upwards questionnaire, after which control grouping participants besides used Family Healthware™, so that their familial risks could exist compared with the intervention group.

Purpose of these analyses

This article reports on the human relationship between participants' perceptions of personal risk, worry, and control over each affliction shortly earlier recording a detailed family unit medical history, and the level of familial take a chance calculated by Family Healthware™. Cantankerous-exclusive analyses of the baseline data from all 2330 participants in the intervention group of FHITr were conducted. Control grouping participants were excluded from the current assay, considering they did not record their family histories until the end of follow-up, using Family Healthware™ 6 months subsequently the baseline questionnaire. The details of the study methods,¹⁹ baseline data collection,^nineteen,20 and Family Healthware™¹⁷ take been described previously. The protocol was canonical past Institutional Review Boards at the CDC and each participating establishment.

Setting and eligibility

Twenty-three principal care practices (iii gynecology, vii internal medicine, and 13 family practices), affiliated with three academic centers and the American Academy of Family unit Physicians' National Research Network, systematically invited patients anile 35–65 years into the intervention group. Fourteen practices in Northern Illinois and one each in California, Florida, Montana, New Jersey, Ohio, and Virginia sent invitation messages to consecutive patients aged 35–65 years who had upcoming appointments with their primary care clinicians, while three group practices in Michigan sent invitation letters to the unabridged potentially eligible patient panels of participating clinicians.¹⁹ Nonpregnant patients were eligible if they had not been diagnosed with CHD, DM, ST, or cancer. About were not further screened for eligibility before receiving a letter of the alphabet of invitation. Medical record review in practices at site E revealed that xiii% of the patients invited did have one or more chronic diseases that excluded them from participating (W. Rubinstein, unpublished data).

Items and instruments

Participants start completed an on-line questionnaire measuring demographics, self-reported health status (short form 12), personal risk factors (including body mass index [BMI], physical action, daily fruit and vegetable intake, and smoking), and health perceptions including worry, perceived personal run a risk, and perceived control over getting each of six mutual adult diseases: CHD, ST, DM, CC, BC, and OC. Those in the intervention group soon later on used the web-based Family unit Healthware™ questionnaire to record their detailed family medical history of these diseases. Family Healthware™ stratified familial risk for each disease.

Dependent variables

Single items using 5-point Likert scales measured these constructs for each disease: perceived personal risk: "Compared to most people your age and sex, what would you say your chances are for developing _____ [illness]? (much lower than boilerplate to much higher than average)."^21,22 Worry: "During the by 4 weeks, how often take y'all idea about your chances of getting _______? ('non at all' to 'almost all the fourth dimension')."²³ Perceived Control: "There's a lot I tin can do to foreclose ______ [disease]. ('strongly disagree' to 'strongly concord')."²⁴

Family history-based chance stratification

The algorithms used in Family Healthware™ to stratify the familial risk of each disease based on family unit history have been described¹⁷ and validated for DM and CHD using epidemiologic data.^25–28 The algorithms take into business relationship number of affected beginning and second-caste relatives, their genders and ages at diagnosis, and patterns of related diseases.²⁹ Familial run a risk is categorized for each affliction, using these algorithms, every bit weak (i.due east., like to general population chance), moderate (east.thousand., 1 kickoff degree relative with the disease diagnosed in center age), or strong.

Statistical analysis

We examined the data for homoscedasticity assumption violations and found statistically significant heterogeneous variances for worry and perceived control. However, analysis of log transformed and untransformed data were basically identical; thus, only analyses of the untransformed data are presented here.

To account for multiple hypothesis testing and the correlated nature of health run a risk perceptions, we chose a multivariate analysis of variance approach to simultaneously analyze perceived risk, worry, and control for each disease. Wilks' lambda criterion was chosen as the omnibus multivariate test statistic. Initially, unadjusted multivariate analysis of variance comparisons were fabricated among the three Family Healthware™ risk strata for each disease. This was followed by computation of multivariate analyses of covariance to adjust for report site, demographic, and personal risk factors found to confound the unadjusted analyses of perceived risk, worry, and control.

Finally, hierarchical linear regression analyses were conducted, for each perception outcome, to assess the independent contribution of demographic factors, potentially modifiable personal take chances factors, and finally, family history risk category. All statistical analyses were conducted using SPSS version xvi.0 (Statistical Package for the Social Sciences, 2007).

Results

Participant characteristics

Intervention group practices systematically invited xiv,888 patients; 2,650 patients considered themselves eligible and gave consent and two,330 (xv.7% of those invited and 88% of those consented) completed the study questionnaires. Participants ranged in age from 35 to 65 years, with a mean of 50 years. Seventy percent were women, 91% Caucasian (4% Blackness, 3% Asian, and 2% Hispanic), 72% college educated (9% high school or below and 19% some college or technical schoolhouse), and 53% endorsed a household income >$75,000. The distribution of familial risk for each disease is shown in Table 1. We have previously published data indicating that female gender and increasing age were the only demographic variables related to increased family history-based risk in this sample.^xix

Tabular array i

Relationship of perceived chance, worry, and perceived control to familial risk computed on the footing of detailed family history

		Adapted means and 95% confidence intervalsa
Family history risk category	N (%)b	Perceived adventure	Worry	Perceived control
Coronary heart disease
Weak	947 (41)	2.42 (two.37–two.48)	1.68 (one.62–1.73)	4.32 (4.28–4.36)
Moderate	615 (27)	2.75 (2.69–ii.82)	ane.ninety (1.82–i.96)	iv.33 (four.28–iv.39)
Strong	768 (33)	iii.01 (2.95–3.07)	two.04 (ane.97–2.10)	4.37 (four.32–four.42)
Total	2330
F		97.0	37.7	1.12
P		<0.001	<0.001	0.326
Consequence size (SD)		0.69	0.43	0.07
Stroke
Weak	1212 (53)	2.52 (2.48–2.57)	ane.44 (1.forty–one.49)	4.01 (3.96–four.05)
Moderate	783 (34)	2.74 (two.69–ii.80)	i.61 (1.56–one.66)	four.02 (iii.96–four.07)
Strong	335 (fourteen)	2.91 (2.83–three.00)	i.71 (i.63–1.79)	4.07 (iii.98–4.16)
Total	2330
F		36.16	20.11	0.82
P		<0.001	<0.001	0.443
Issue size (SD)		0.43	0.33	0.08
Diabetes
Weak	1426 (61)	2.41 (2.36–ii.46)	1.43 (1.39–1.48)	4.08 (four.04–4.12)
Moderate	643 (28)	3.00 (2.93–3.06)	1.75 (i.69–ane.81)	4.15 (4.08–four.21)
Strong	261 (eleven)	3.30 (3.20–iii.41)	ane.96 (1.86–2.06)	4.13 (four.04–4.23)
Full	2330
F		176.51	63.62	1.62
P		<0.001	<0.001	0.198
Outcome size (SD)		0.86	0.59	0.06
Colon cancer
Weak	2015 (88)	2.60 (two.57–2.64)	1.36 (1.33–ane.39)	iii.80 (three.76–3.83)
Moderate	263 (11)	3.26 (3.sixteen–3.35)	1.68 (1.59–1.76)	3.85 (3.75–3.95)
Stiff	52 (2)	3.53 (3.32–3.74)	i.90 (1.71–2.09)	3.89 (iii.66–iv.11)
Total	2330
F		116.33	36.49	0.73
P		<0.001	<0.001	0.484
Upshot size (SD)		1.12	0.75	0.eleven
Breast cancer (women only)
Weak	1251 (76)	2.72 (2.68–2.76)	one.83 (1.78–ane.88)	iii.32 (iii.27–3.38)
Moderate	233 (14)	3.45 (3.36–3.54)	ii.17 (2.05–2.29)	3.27 (iii.15–3.40)
Strong	172 (10)	3.58 (3.47–iii.69)	2.26 (two.12–2.39)	3.26 (3.12–3.twoscore)
Total	1656
F		179.10	26.19	0.52
P		<0.001	<0.001	0.597
Effect size (SD)		1.05	0.46	0.06
Ovarian cancer (women only)
Weak	1383 (ix)	2.75 (ii.72–2.79)	one.42 (ane.38–1.46)	2.97 (2.92–3.02)
Moderate	84 (half-dozen)	3.17 (3.03–three.31)	1.65 (ane.49–1.81)	2.97 (2.78–3.17)
Stiff	56 (4)	2.99 (2.81–3.16)	1.56 (1.36–ane.76)	3.03 (2.lxxx–3.27)
Total	1523c
F		19.05	4.55	0.13
P		<0.001	0.011	0.875
Effect size (SD)		0.35	0.18	0.07

Correlations of perceived risk, worry, and command

Among the 6 diseases, perceived risk was moderately correlated with worry (Pearson correlation coefficients ranged from 0.xxx for OC to 0.53 for DM, all significant at P < 0.001). Higher perceived hazard was correlated with lower perceived command for nigh of the diseases (coefficients ranged from −0.03 for DM to −0.12 for BC). Worry was not significantly correlated with perceived control for about diseases (coefficients ranged from 0.004 for BC to 0.10 for DM). These modest correlations advise that the items measured singled-out constructs, while confirming that it was appropriate to business relationship for some correlation among the perceptions in analyzing their relationship to familial run a risk.

Human relationship of perceptions to family history-based risk categories

In this sample as a whole, the mean level of perceived risk for each disease (from ii.65 to ii.78 on a scale of 1–five) corresponds to the response: "most the same equally average". However, the levels of perceived personal hazard for each disease were strongly related to the family history risk category assigned by Family unit Healthware™ algorithms. Tabular array ane shows that family unit history risk category for each illness remained associated with perceived hazard (P < 0.001 for each disease) when the analyses were adapted for personal risk factors that are associated with family unit history, including age, education, BMI, smoking, diet, and physical activity. The result of family history on perceived risk ranged from 0.35 standard difference for OC (a small consequence merely potentially clinically meaningful)³⁰ to 1.12 standard deviation (a big outcome) for CC.

In full general, study participants, themselves free of all six diseases, rarely worried or thought about their chances of developing chronic diseases. (The response pick ii corresponded to "rarely".) However, familial risk category was positively and strongly associated with worry for each disease, later adjustment for personal risk factors and general health, as shown in Table ane (P < 0.001 for each affliction except OC). For worry, the clinically pregnant effect sizes varied from 0.33 standard deviations for ST to 0.75 standard deviations for CC. In contrast, perceived control (ability to prevent the illness) was non related to familial risk category for whatever disease. Almost participants agreed that there is a lot they could practise to prevent the diseases, although cancers were seen equally less preventable than heart disease, irrespective of family history.^twenty

Effigy i shows the results of stepwise regression analyses of perceived risk for each illness. The percent of the variance in perceived take chances that is explained by demographic characteristics such as historic period, gender, and study site is small-scale. Adding personal health status, BMI, smoking, and concrete action accounts for a big portion of the variability in perceived hazard for cardiovascular diseases (xviii% for ST and 22% for heart disease) and diabetes (19%). Family history-based risk category adds substantial predictive ability, especially for perceived risk of common cancers, explaining 10% of the variance in perceived risk for diabetes, 8% for CC, and 16% for BC, independent of personal characteristics.

Proportion of variation in perceived risk explained by demographic, personal risk factors, and family history run a risk categories. Graph shows R ² from stepwise regression analyses for each disease. Numbers above each bar refer to the variance in perceived risk associated with family history risk category. Hazard perception for BC and OCs was measured only for women; OC take chances perception was measured only for women with ovaries.

Table 2 shows that a majority of people categorized by Family Healthware™ at increased familial risk of a affliction did not consider themselves to have increased risk of developing the disease, compared with well-nigh people their age and sex. Even among participants with strong familial take a chance of a disease, ix% (BC) to thirty% (ST) perceived themselves having below or much below boilerplate hazard (non shown separately in tabular array). Thus, although family history was correlated with gamble perception, we found evidence of an optimistic bias with 48–79% of people with a moderate or potent familial risk level still perceiving themselves at boilerplate or below average risk. A smaller proportion (4–12%) believed themselves at increased run a risk of a disease despite having average or beneath average risk based on family history.

Tabular array 2

Proportion of participants who perceived themselves at boilerplate or below average risk despite a moderate or potent family history risk

Disease	Northward at moderate or potent familial gamble, according to Family Healthware	Percentage of N who perceived themselves at above or much above average chance (earlier using Family Healthware)	Percentage of N who perceived themselves at average or below average risk
Coronary centre afflictiona	1383	30	seventy
Strokea	1118	21	79
Diabetesa	904	40	threescore
Colon cancera	315	46	54
Chest cancerb	405	52	48
Ovarian cancerc	140	30	seventy

Give-and-take

In a large sample from primary care, the FHITr found that, for half dozen common diseases, perceived adventure and worry about developing the disease are strongly associated with familial chance calculated from detailed family unit medical history. Regardless of risk level, most affliction-complimentary individuals seldom worried or thought about their risk of developing these diseases. Perceived control over preventing these diseases was non associated with family history-based risk.

Several overarching statements can exist fabricated based on the report findings and supported by existing literature. First, family history seems to be associated with take a chance perceptions.^31–36 This written report supports the existing literature by demonstrating the consistency of this finding across several diseases, afterward adjusting for personal factors that themselves may aggregate in families: i.eastward., age, gender, education, BMI, and wellness behaviors (e.g., fruit and vegetable intake, physical activeness, and smoking).

Second, the majority of people currently in good wellness are optimistically biased about their risks for developing mutual, chronic conditions. Although psychological research has demonstrated that, in general, people feel they are at lower disease risk when compared with others,^22,37 this report reveals that this bias seems prevalent even among those with a moderate or strong family history of disease. Importantly, these findings remind researchers that fifty-fifty if gamble perceptions are correlated with family unit history, many individuals would notwithstanding have potential to increase their perceived risk in response to familial risk cess. However, given some evidence of a protective effect of optimistic bias, for example, a lower cardiovascular disease (CVD) mortality rate observed amidst men with optimistically biased CVD take chances perceptions,³⁸ it will be important to understand the circumstances in which heightened sensation of familial take a chance may or may not benefit health. A net do good of raising risk awareness may, in part, depend on the perceived availability and efficacy of measures to reduce risk.¹⁴

A minor proportion of participants in this written report believed that they were at elevated risk when their familial risk, equally assessed by Family Healthware™, was not increased. Possibly these individuals were aware of personal risk factors other than reported family unit history. Thus, it was not possible in this report to determine whether these individuals were pessimistically biased or relatively authentic in their take a chance perceptions.

Tertiary, for study participants equally a group, the forcefulness of family history does not seem to be associated with perceptions of disease controllability. This finding, amongst people enlightened of their family unit medical history at baseline, may allay concerns that carrying information near familial or hereditary take chances could increase fatalistic beliefs.³⁹ More than recent evidence suggests that learning about familial or hereditary risk for diseases such equally diabetes does not increment fatalism and may fifty-fifty increase perceptions of control.^twoscore

Limitations

This report had several limitations. Single-particular measures for perceived risk, worry, and command were used in efforts to minimize response burden when assessing perceptions across half dozen diseases. These measures may not have captured the total range of variability in health perceptions. As participants were selected for absence of the six diseases, they are healthier than many middle-aged patients seen in main care; the effect of freedom from these chronic diseases on wellness perceptions could not be measured.

Many centre-aged patients seeing master care physicians have chronic diseases that would have excluded them from eligibility for this trial. The overall proportion of those invited who would have been eligible to participate in this report (gratuitous of all six common diseases) is unknown. However, medical tape review in practice at site Eastward revealed that xiii% of the patients invited did have i or more chronic diseases that excluded them from participating (West. Rubinstein, unpublished data). Nonetheless, over all sites, only 15.vii% of those invited participated in this written report, raising concerns about whether their health beliefs are representative. The finding that prevalence of a family history of BC, diabetes, or CHD in these study participants is similar to that in population-based surveys suggests that the sample was non strongly self-selected for higher familial hazard.^28,41,42

Demographics of the study practices (a majority in suburban Chicago) limited the proportion of participants from lower socioeconomic and minority groups and increased the proportion of female participants. It is also probable that use of internet questionnaires selected people more accustomed to computer use, although many patients were offered an option to use a computer in the medico'due south office or to report measures through a structured telephone interview. The sample is above average in terms of education and income, thus potentially limiting the generalizability of these findings to other populations.

Implications of these findings for practice and research

Family Healthware™ and other tools are designed to systematically assess family medical history to target preventive efforts to families at increased risk for diseases. Baseline data from FHITr indicate that cocky-reported family history of a disease has a clinically important (moderate to large) association with unaffected individuals' perceived risk of developing the disease, and a moderate effect on frequency of thinking about their chances of developing information technology, before answering any questions nigh family unit history. Thus, interventions to increment patients' awareness of illness risk based on family history may encounter a ceiling consequence equally a result of people's lifelong sensation of their family unit medical history. Nonetheless, to the extent that clinicians are ofttimes unaware, particularly of familial cancer risk, family unit history cess in the clinical context could impact clinician awareness and recommendations.^43–45

The availability of self-administered family history assessment tools expands the feasibility of studying the relationship between family history perceptions and hazard-reducing actions, both unprompted and in response to interventions targeted to familial risk. So far, near data on this take come up from selected high-chance groups. The findings of this report, consistent with Walter and Emery'southward interview study of British GP patients,^xi suggest that fatalistic beliefs with regard to family history of several common diseases are not prevalent among healthy, relatively well-to-practice master intendance patients (see likewise, McBride et al.⁹). Analyses of follow-upwards information from FHITr will show whether family history-based prevention messages affected preventive behaviors or changed perceptions nearly disease risk and prevention.

Acknowledgments

The Family unit Healthware Affect Trial (FHITr) Grouping consists of the following collaborators: From the CDC: Paula W. Yoon, ScD, MPH; Rodolfo Valdez, PhD; Margie Irizarry-De La Cruz, MPH; Muin J. Khoury, Physician, PhD; Cynthia Jorgensen, Dr PH. From the Rand Corporation: Maren T. Scheuner, Physician, MPH. From Northshore Academy HealthSystem, Evanston, IL: Suzanne Thousand. O'Neill, MA, MS, PhD, Chief Investigator; Wendy Southward. Rubinstein, MD, PhD, Principal Investigator; Nan Rothrock, PhD; Jennifer 50. Beaumont, MS; Shaheen Khan, MS, MBA, MPH; Dawood Ali, MS. From the University of Illinois at Chicago: Erin J. Starzyk, MPH. From Boston University School of Public Health: Catharine Wang, PhD, MSc. From the University of Michigan: Mack T. Ruffin, IV, MD, MPH, Principal Investigator; Donald E. Nease, Jr., MD, Principal Investigator. From Case Western Reserve Academy, University Hospitals Case Medical Heart: Louise S. Acheson, MD, MS, Primary Investigator; Stephen J. Zyzanski, PhD; Georgia L. Wiesner, Medico; James Werner, PhD. From the University of Rochester: Robert Gramling, Dr., DSc. From the American University of Family Physicians' National Enquiry Network: Wilson D. Pace, Dr., Principal Investigator; James M. Galliher, PhD; Elias Brandt, BS, BA.

The Family unit Healthware™ Impact Trial (FHITr) was supported through cooperative agreements between the Centers for Disease Control and the Association for Prevention Teaching and Enquiry (ENH-U50/CCU300860 TS-1216) and the American Clan of Medical Colleges (UMU36/CCU319276 MM-0789 and CWR U36/CCU319276 MM0630). Dr. Acheson received salary support from NCI K07 CA86958 in Cancer Prevention and Control. None of the authors has a conflict of interest germane to the information presented in this report.

Presented, in part, at the North American Primary Care Research Grouping Annual Coming together, San Juan, Puerto Rico, November 2008.

Footnotes

Disclosure: The authors declare no conflict of interest.

References

1. Acheson LS, Wiesner GL, Zyzanski SJ, Goodwin MA, Stange KC. Family unit history-taking in community family practice: implications for genetic screening. Genet Med. 2000;2:180–185. [PubMed] [Google Scholar]

2. Suther Due south, Goodson P. Barriers to the provision of genetic services by primary care physicians: a systematic review of the literature. Genet Med. 2003;5:seventy–76. [PubMed] [Google Scholar]

three. Rich E, Burke W, Heaton CJ, et al. Reconsidering the family unit history in primary care. J Gen Intern Med. 2004;19:273–280. [PMC free article] [PubMed] [Google Scholar]

iv. Qureshi Northward, Wilson B, Santaguida P, et al. Collection and use of cancer family unit history in primary intendance. Rockville, Dr.: Agency for Healthcare Research and Quality; 2007. [Google Scholar]

five. Hughes 1000. NIH State-of-the-Scientific discipline Conference: Family History and Improving Health. Bethesda, Doctor: National Institutes of Health; 2009. Health IT-based strategies for studying the utilise of family history in primary care (abstract) pp. 87–90. [Google Scholar]

6. Feero WG, Bigley MB, Brinner K Family Health History Multi-Stakeholder Workgroup of the American Health Information Customs. New standards and enhanced utility for family health history information in the electronic wellness record: an update from the American Health Information Community'south Family Health History Multi-Stakeholder Workgroup. J Am Med Inform Assoc. 2008;xv:723–728. [PMC gratuitous article] [PubMed] [Google Scholar]

7. Yoon PW, Scheuner MT, Khoury MJ. Enquiry priorities for evaluating family unit history in the prevention of mutual chronic diseases. Am J Prev Med 2003. 2003;24:128–135. [PubMed] [Google Scholar]

eight. Acheson Fifty. NIH State-of-the-Science Conference: Family unit History and Improving Wellness. Bethesda, MD: National Institutes of Health; 2009. Research challenges in assessing risk with family unit history (abstract) pp. 31–34. [Google Scholar]

9. McBride CM, Alford SH, Reid RJ, Larson EB, Baxevanis AD, Brody LC. Characteristics of users of online personalized genomic risk assessments: implications for dr.-patient interactions. Genet Med. 2009;xi:582–687. [PMC complimentary article] [PubMed] [Google Scholar]

10. Walter FM, Emery J, Braithwaite D, Marteau TM. Lay understanding of familial risk of mutual, chronic diseases: a systematic review and synthesis of qualitative research. Ann Fam Med. 2004;3:583–594. [PMC gratis article] [PubMed] [Google Scholar]

11. Walter FM, Emery J. 'Coming down the line'– patients' understanding of their family history of mutual chronic disease. Ann Fam Med. 2005;iii:405–414. [PMC free article] [PubMed] [Google Scholar]

12. Becker M. The health belief model and personal health beliefs. Health Educ Monogr. 1974;two:324–473. [Google Scholar]

13. Janz NK, Becker MH. the health belief model: a decade later. Health Educ Q. 1984;11:1–47. [PubMed] [Google Scholar]

xiv. Witte K. Putting the fear back into fearfulness appeals: the extended parallel process model. Commun Monogr. 1992;61:113–134. [Google Scholar]

15. Vernon SW. Take a chance perception and gamble communication for cancer screening behaviors: a review. J Natl Cancer Inst Monogr. 1999;25:101–119. [PubMed] [Google Scholar]

16. Senior V, Marteau T, Weinman J. Impact of genetic testing on causal models of heart illness and arthritis: an counterpart study. Psychol Health. 2000;14:1077–1088. [PubMed] [Google Scholar]

17. Yoon Pw, Scheuner MT, Jorgensen C, Khoury MJ. Developing family Healthware, a family unit history screening tool to prevent common chronic diseases. Prev Chronic Dis. 2009;6:A33. [PMC free commodity] [PubMed] [Google Scholar]

xix. O'Neill SM, Rubinstein WS, Wang C, et al. Family Healthware Impact Trial group. Familial risk for common diseases in primary intendance: the Family unit Healthware Touch Trial. Am J Prev Med. 2009;36:506–514. [PubMed] [Google Scholar]

xx. Wang C, O'Neill SM, Rothrock N, et al. Family Healthware Touch Trial (FHITr) grouping. Comparison of gamble perceptions and behavior beyond common chronic diseases. Prev Med. 2009;48:197–202. [PMC free commodity] [PubMed] [Google Scholar]

21. Weinstein N. Unrealistic optimism near future life events. J Person Soc Psychol. 1980;39:806–820. [Google Scholar]

22. Weinstein N. Unrealistic optimism about susceptibility to health issues. J Behav Med. 1982;v:441–460. [PubMed] [Google Scholar]

23. Anderson MR, Smith R, Meischke H, Bowen D, Urban N. Breast cancer worry and mammography utilize by women with and without a family history in a population-based sample. Cancer Epidemiol Biomarkers Prev. 2003;12:314–320. [PubMed] [Google Scholar]

24. Witte K, Cameron KA, McKeon JK, Berkowitz JM. Predicting risk behaviors: development and validation of a diagnostic scale. J Wellness Commun. 1996;1:317–341. [PubMed] [Google Scholar]

25. Hariri S, Yoon P, Qureshi Due north, Valdez R, Scheuner MT, Khoury MJ. Family history of blazon 2 diabetes: a population-based screening tool for prevention? Genet Med. 2006;eight:102–108. [PubMed] [Google Scholar]

26. Hariri Southward, Yoon Pow, Moonesinghe R, Valdez R, Khoury MJ. Evaluation of family unit history as a risk factor and screening tool for detecting undiagnosed diabetes in a nationally representative survey population. Genet Med. 2006;8:752–759. [PubMed] [Google Scholar]

27. Scheuner MT, Whitworth WC, McGruder H, Yoon Pw, Khoury MJ. Expanding the definition of a positive family history for early on-onset coronary heart disease. Genet Med. 2006 Aug;8:491–501. [PubMed] [Google Scholar]

28. Scheuner MT, Whitworth WC, McGruder H, Yoon Pow, Khoury MJ. Familial risk assessment for early-onset coronary centre illness. Genet Med. 2006;8:525–531. [PubMed] [Google Scholar]

29. Scheuner MT, Wang SJ, Raffel LJ, Larabell SK, Rotter JI. Family unit history: a comprehensive genetic hazard assessment method for the chronic weather condition of adulthood. Am J Med Genet. 1997;71:315–324. [PubMed] [Google Scholar]

thirty. Middel B, Stewart R, Bouma J, van Sonderen East, van den Heuvel Due west. How to validate clinically important change in health-related functional status. Is the magnitude of the outcome size consistently related to magnitude of change as indicated past a global question rating? J Eval Clin Pract. 2001;7:399–410. [PubMed] [Google Scholar]

31. Kelly M, Ferketich A, Sturm A, et al. Cancer gamble and take a chance communication in urban, lower-income neighborhoods. Prev Med. 2009;48:392–396. [PubMed] [Google Scholar]

32. Jacobsen Pb, Lamonde LA, Honour M, Kash K, Hudson PB, Pow-Sang J. Relation of family unit history of prostate cancer to perceived vulnerability and screening behavior. PsychoOncology. 2004;13:80–85. [PubMed] [Google Scholar]

33. Montgomery GH, Erblich J, DiLorenzo T, Bovbjerg DH. Family and friends with affliction: their impact on perceived risk. Prev Med. 2003;37:242–249. [PubMed] [Google Scholar]

34. Hay J, Coups E, Ford J. Predictors of perceived risk for colon cancer in a national probability sample in the U.s.a.. J Health Commun. 2006;eleven(suppl 1):71–92. [PubMed] [Google Scholar]

35. Robb K, Miles A, Wardle J. Demographic and psychosocial factors associated with perceived risk for colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2004;13:366–372. [PubMed] [Google Scholar]

36. Katapodi MC, Dodd MJ, Lee KA, Facione NC. Underestimation of breast cancer risk: influence on screening behavior. Oncol Nurs Forum. 2009;36:306–314. [PubMed] [Google Scholar]

37. Weinstein ND. Unrealistic optimism almost susceptibility to health bug: conclusions from a community-broad sample. J Behav Med. 1987;10:481–500. [PubMed] [Google Scholar]

38. Gramling R, Klein Due west, Roberts One thousand, Waring ME, Gramling D, Eaton CB. Cocky-rated cardiovascular risk and 15-yr cardiovascular bloodshed. Ann Fam Med. 2008;half-dozen:302–306. [PMC costless commodity] [PubMed] [Google Scholar]

39. Senior V, Marteau TM, Peters TJ. Will genetic testing for predisposition for disease outcome in fatalism? A qualitative written report of parents responses to neonatal screening for familial hypercholesterolaemia. Soc Sci Med. 1999;48:1857–1860. [PubMed] [Google Scholar]

xl. Pijl M, Timmermans DR, Claassen L, et al. Affect of communicating familial risk of diabetes on illness perceptions and self-reported behavioral outcomes: a randomized controlled trial. Diabetes Care. 2009;32:597–599. [PMC free article] [PubMed] [Google Scholar]

41. Ramsey SD, Yoon P, Moonesinghe R, Khoury MJ. Population-based written report of the prevalence of family history of cancer: implications for cancer screening and prevention. Genet Med. 2006;8:571–575. [PMC gratis commodity] [PubMed] [Google Scholar]

42. Valdez R, Yoon PW, Liu T, Khoury MJ. Family unit history and prevalence of diabetes in the Us population: 6-year results from the National Health and Nutrition Exam Survey (NHANES, l999–2004) Diabetes Intendance. 2007;xxx:17–32. [PubMed] [Google Scholar]

43. Frezzo TM, Rubinstein WS, Dunham D, Ormond KE. The genetic family history as a risk assessment tool in internal medicine. Genet Med. 2003;v:84–91. [PubMed] [Google Scholar]

44. O'Neill S, Starzyk East, Kattezham R, WS R. Comparison of family Healthware™ and physicians' family history documentation among 1124 patients (abstruse). Presented at the American Guild of Human Genetics Almanac Meeting; Philadelphia, PA. 2008. [Google Scholar]

45. Emery J, Morris H, Goodchild R, et al. The GRAIDS trial: a cluster randomized controlled trial of computer determination support for the management of familial cancer risk in primary intendance. Br J Cancer. 2007;97:486–493. [PMC free article] [PubMed] [Google Scholar]

hathawayenditarray.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037165/