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PPO 09-241 – HSR&D Study

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PPO 09-241
Processes Associated with the Use of Family Health History Information at the VHA
Nedal H. Arar PhD MA MS
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: June 2010 - May 2011

BACKGROUND/RATIONALE:
Using detailed family health history (FHH) information will be increasingly important for accurate personalized familial risk assessments and will complement any current or future genetic screening. Several online tools (e.g., Surgeon General (SG) FHH tool) have been developed to facilitate the collection and documentation of FHH information.

OBJECTIVE(S):
The ultimate goal of our work is to improve processes related to familial risk assessments at the VHA. Specific aims were to: (1) examine veterans' knowledge, attitudes and practices about the importance of their FHH information, (2) assess veterans' actual use of their FHH information, and (3) examine providers' views regarding the use of detailed FHH information during patients' visit to the primary care outpatient clinics.

METHODS:
Fifty veterans at the VA Medical Center in San Antonio, TX responded to the study's surveys, completed the online SG-FHH tool, and received a printed copy of their family pedigree. A subset of 12 veterans with moderate/high familial risk for a chronic disease was selected for a follow-up phone interview after 6 months of their enrollment. Semi-structured interviews were conducted with 15 providers. Open-ended questions elicit information on the importance, facilitator and barriers to using detailed FHH information during patients' visit. Each interview lasted about 40 minutes, tape-recorded, transcribed and content analyzed.

FINDINGS/RESULTS:
The average age of the participated veterans was 50.2 8.5. The majority (88%) was male and 64% had at least some college education. About 94% viewed the SG-FHH tool as useful and indicated that they would recommend the tool to others. Nearly all participants (90%) agreed that FHH refers to health information regarding diseases in the family and knowing FHH can help identify risks for common chronic diseases. About 71% indicated that having a close blood relative with a disease and multiple affected relatives would increase their risk of developing that disease, but only 58% agreed that having young affected relatives would increase their risk. Almost 82% believed that it is possible to prevent/minimize their risks of developing common chronic diseases. Despite these positive attitudes, 50% reported speaking to their providers and relatives about FHH, and 40% reported collecting FHH information. Of the 12 veterans who completed the follow-up phone interviews, two reported presenting their FHH information to their relatives none reported presenting their FHH information to providers. All participating primary care providers perceived genomic medicine as an important area that will have a positive impact on common diseases outcomes. They agreed that the VHA has the necessary infrastructure to facilitate processes related to familial risk assessment. Providers also indicated that collecting and recording FHH before patients' visits may facilitate the adoption and delivery of FHH as genomic and clinical tool.

IMPACT:
This study provided data on the performance and acceptability of an inexpensive method that can facilitate familial risks assessment and be integrated into clinical practice to enhance screening and identification of veterans with familial risks for common chronic diseases.



PUBLICATIONS:

Journal Articles

  1. Arar N, Seo J, Abboud HE, Parchman M, Noel P. Veterans' experience in using the online Surgeon General's family health history tool. Personalized medicine. 2011 Sep 1; 8(5):523-532.
  2. Arar N, Seo J, Lee S, Abboud HE, Copeland LA, Noel P, Parchman M. Preferences regarding genetic research results: comparing veterans and nonveterans responses. Public health genomics. 2011 Apr 7; 13(7-8):431-9.
  3. Arar NH, Seo J, Abboud HE, Parchman ML, Noel PH. Providers' behavioral beliefs regarding the delivery of genomic medicine at the Veterans Health Administration. Personalized medicine. 2010 Sep 29; 7(5):485-494.
Conference Presentations

  1. Arar NH, Parchman ML, Noel PH. Understanding Providers’ Views Regarding the Delivery of Genomic Medicine at the VHA Through the Lens of the Theory of Planned Behavior. Poster session presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA.
  2. Arar NH, Seo J, Parchman ML, Noel PH. Providers’ Views Regarding the Delivery of Genomic Medicine at the VHA Using Complexity Science Theory. Poster session presented at: Genomic Applications in Practice and Prevention Network Conference; 2009 Oct 30; Ann Arbor, MI.


DRA: Health Systems
DRE: Genomics
Keywords: Attitudes/Beliefs, Decision Support, Practice Patterns/Trends
MeSH Terms: none

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