Understanding how physicians and patients communicate about family health history: An observational study

BACKGROUND: Few studies have examined the extent to which primary care doctors collect family history information and little is known about how and whether this information is discussed or used to provide recommendations. This study had two primary objectives: (1) to examine the prevalence and characteristics of family health history discussions (FHDs) in a low-income primary care population, and (2) to identify the context, process, content, and outcomes of those discussions. METHODS: Ninety videotaped primary care visits from a low-income urban practice were reviewed and every instance in which family health history was discussed was identified. We coded the timing, content, process, context and communication outcomes for each instance using two independent coders. RESULTS: The average age of videotaped patients was 46, 64% had an annual household income less than 40K, and 48% had a high school education or less. Family history was discussed in 22% of visits and there were a total of 31 FHDs. The average length of a FHD was 40 seconds. Several key findings were identified. First, the most common types of disorders discussed were cancer (35% of FHDs). Information about personal risk and about screening were more common information types (32% and 13% respectively). Second, screening or prevention recommendations were provided infrequently (30% of FHDs). CONCLUSIONS: These findings indicate that communication is infrequent and nonspecific about family history. Intervention research aimed at increasing the frequency and type of FHDs in primary care might be needed to increase the utility of family health history information.