Translating environmental health research into clinical practice: A survey of Pediatric Hematologists and Oncologists

Clinical practice plays an important role in advancing children's environmental health and preventing harmful exposures. Specifically, clinical history taking can enhance data collection and promote doctor-patient communications in this area. While scientific studies have recently highlighted evidence of environmental contributions to the incidence of childhood leukemia worldwide, we hypothesize that there have not been corresponding advances in the clinical world to incorporate this evidence into routine practice. To test this assumption, we conducted a survey of Pediatric Hematologists and Oncologists to assess their environmental history-taking behavior and perceptions of environmental health evidence relevant to their work. The survey was piloted among a group of practitioners at Lucile Packard Children's Hospital at Stanford, and expanded to include members of professional clinical networks across the country. Results indicate that environmental exposures are of concern to clinicians, but a lack of familiarity or comfort in discussing these issues with patient's families presents a significant barrier. Although a substantial percentage of practitioners often suspected cases to have environmental etiologies, rates of asking about environmental exposures during routine history taking were low and the questions inconsistent. This research implies a need for increased training and awareness of environmental health among clinical practitioners, and interventions related to history taking practices such as identifying behavior change strategies or incorporating self-administered intake questionnaires into patient care.