title: Lay understanding of familial risk of common chronic diseases: a systematic review and synthesis of qualitative research.
abstract: OBJECTIVE
  Although the family history is increasingly used for genetic risk assessment of common chronic diseases in primary care, evidence suggests that lay understanding about inheritance may conflict with medical models. This study systematically reviewed and synthesized the qualitative literature exploring understanding about familial risk held by persons with a family history of cancer, coronary artery disease, and diabetes mellitus.
  
  
  METHODS
  Twenty-two qualitative articles were found after a comprehensive literature search and were critically appraised; 11 were included. A meta-ethnographic approach was used to translate the studies across each other, synthesize the translation, and express the synthesis.
  
  
  RESULTS
  A dynamic process emerged by which a personal sense of vulnerability included some features that mirror the medical factors used to assess risk, such as the number of affected relatives. Other features are more personal, such as experience of a relative's disease, sudden or premature death, perceived patterns of illness relating to gender or age at death, and comparisons between a person and an affected relative. The developing vulnerability is interpreted using personal mental models, including models of disease causation, inheritance, and fatalism. A person's sense of vulnerability affects how that person copes with, and attempts to control, any perceived familial risk.
  
  
  CONCLUSIONS
  Persons with a family history of a common chronic disease develop a personal sense of vulnerability that is informed by the salience of their family history and interpreted within their personal models of disease causation and inheritance. Features that give meaning to familial risk may be perceived differently by patients and professionals. This review identifies key areas for health professionals to explore with patients that may improve the effectiveness of communication about disease risk and management.
authors.affiliation: General Practice & Primary Care Research Unit, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK. fmw22@medschl.cam.ac.uk
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.forename: Dejana
authors.initials: D
authors.lastname: Braithwaite
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Marteau
mesh_terms: D002908:Chronic Disease; D003695:Delivery of Health Care; D005190:Family; D005192:Family Health; D006801:Humans; D008954:Models, Biological; D036301:Qualitative Research; D012307:Risk Factors