Familial Risk for Common Diseases in Primary Care: The Family Healthware™ Impact Trial
Context
Family history is a risk factor for many common chronic diseases, yet it remains underutilized in primary care practice.
Background
Family Healthware™ is a self-administered, web-based tool that assesses familial risk for CHD; stroke; diabetes; and colorectal, breast, and ovarian cancer, and provides a personalized prevention plan based on familial risk. The Family Healthware Impact Trial evaluated the tool.
Design
In this cluster RCT, participants completed baseline and 6-month follow-up surveys. The intervention group used Family Healthware directly after the baseline survey. Controls used the tool after completing the follow-up survey.
Setting/participants
Patients aged 35–65 years with no known diagnosis of these six diseases were enrolled from 41 primary care practices.
Main outcome measures
The prevalence of family-history–based risk for coronary heart disease (CHD); stroke; diabetes; and colorectal, breast, and ovarian cancer was determined in a primary care population.
Results
From 2005 to 2007, 3786 participants enrolled. Data analysis was undertaken from September 2007 to March 2008. Participants had a mean age of 50.6 years and were primarily white (91%) women (70%). Of the 3585 participants who completed the risk assessment tool, 82% had a strong or moderate familial risk for at least one of the diseases: CHD (strong=33%, moderate=26%); stroke (strong=15%, moderate=34%); diabetes (strong=11%, moderate=26%); colorectal cancer (strong=3%, moderate=11%); breast cancer (strong=10%, moderate=12%); and ovarian cancer (strong=4%, moderate=6%). Women had a significantly (p<0.04) higher familial risk than men for all diseases except colorectal and ovarian cancer. Overweight participants were significantly (p≤0.02) more likely to have a strong family history for CHD, stroke, and diabetes. Older participants were significantly (p≤0.02) more likely to report a strong family history for CHD and stroke as well as colorectal and breast cancer.
Conclusions
This self-administered, online tool delineated a substantial burden of family-history–based risk for these chronic diseases in an adult, primary care population.
aCenter for Medical Genetics, NorthShore University HealthSystem (formerly Evanston Northwestern Healthcare), Evanston, Illinois
bCenter on Outcomes Research and Education (Rothrock, Beaumont), NorthShore University HealthSystem (formerly Evanston Northwestern Healthcare), Evanston, Illinois
cDepartment of Medicine, Feinberg School of Medicine, Northwestern University; the Department of Epidemiology, University of Illinois at Chicago, Chicago, Illinois
dFox Chase Cancer Center, Philadelphia, Pennsylvania
eOffice of Public Health Genomics, CDC, Atlanta, Georgia
fDepartments of Family Medicine and Reproductive Biology and the Case Comprehensive Cancer Center, University Hospitals and Case Western Reserve University, Cleveland, Ohio
gAmerican Academy of Family Physicians' National Research Network, Leawood, Kansas
hDepartment of Family Medicine, University of Michigan, Ann Arbor, Michigan
Address correspondence and reprint requests to: Suzanne M. O'Neill, MA, MS, PhD, Center for Medical Genetics, 1000 Central Street, Suite 620, Evanston IL 60201
ABSTRACT