How is family health history discussed in routine primary healthcare? A qualitative study of archived family doctor consultations

Sara Filoche; Maria H Stubbe; Rebecca Grainger; Bridget Robson; Karyn Paringatai; Phil Wilcox; Regina Jefferies; Anthony Dowell

doi:10.1136/bmjopen-2021-049058

How is family health history discussed in routine primary healthcare? A qualitative study of archived family doctor consultations

BMJ Open. 2021 Oct 5;11(10):e049058. doi: 10.1136/bmjopen-2021-049058.

Authors

Sara Filoche¹, Maria H Stubbe², Rebecca Grainger³, Bridget Robson⁴, Karyn Paringatai⁵, Phil Wilcox⁶, Regina Jefferies⁷, Anthony Dowell²

Affiliations

¹ Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand sara.filoche@otago.ac.nz.
² Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
³ Department of Medicine, University of Otago, Wellington, New Zealand.
⁴ Te Rōpū Rangahau Hauora a Eru Pōmare, Department of Public Health, University of Otago, Wellington, New Zealand.
⁵ Te Tumu, School of Māori, Pacific and Indigenous Studies, University of Otago, Dunedin, New Zealand.
⁶ Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.
⁷ Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, New Zealand.

Abstract

Objectives: Family health history underpins genetic medicine. Our study aimed to explore language and patterns of communication relating to family health history observed in interactions between general practitioners (GPs) and their patients within routine primary care consultations.

Design: Secondary analysis of patient and GP routine consultation data (n=252).

Participants: Consultations that included 'family health history' were eligible for inclusion (n=58).

Primary outcomes: A qualitative inductive analysis of the interactions from consultation transcripts.

Results: 46/58 conversations about family health history were initiated by the GP. Most discussions around family history lasted for between approximately 1 to 2 min. Patients were invited to share family health history through one of two ways: non-specific enquiry (eg, by asking the patient about 'anything that runs in the family'); or specific enquiry where they were asked if they had a 'strong family history' in relation to a particular condition, for example, breast cancer. Patients often responded to either approach with a simple no, but fuller negative responses also occurred regularly and typically included an account of some kind (eg, explaining family relationships/dynamics which impeded or prevented the accessibility of information).

Conclusions: Family health history is regarded as a genetic test and is embedded in the sociocultural norms of the patient from whom information is being sought. Our findings highlight that it is more complex than asking simply if 'anything' runs in the family. As the collection of family health history is expected to be more routine, it will be important to also consider it from sociocultural perspectives in order to help mitigate any inequities in how family history is collected, and therefore used (or not) in a person's healthcare. Orientating an enquiry away from 'anything' and asking more specific details about particular conditions may help facilitate the dialogue.

Keywords: general medicine (see internal medicine); genetics; health services administration & management.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

General Practitioners*
Humans
Medical History Taking
Physician-Patient Relations
Physicians, Family
Primary Health Care
Qualitative Research
Referral and Consultation*