title: Assessing family history of heart disease in primary care consultations: a qualitative study.
abstract: BACKGROUND
  Current primary prevention guidelines recommend the assessment of family history of coronary heart disease (CHD) to identify at-risk individuals.
  
  
  OBJECTIVE
  To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care.
  
  
  METHODS
  A qualitative study. Patients completed a validated family history questionnaire. Consultations with clinicians were video recorded, and semi-structured interviews conducted with patients after consultation. The participants were 21 primary care patients and seven primary care clinicians (two practice nurses, five GPs). Four practices in South West England.
  
  
  RESULTS
  Patients and clinicians usually agreed about the patient's level of risk and how to reduce it. Patients were mostly satisfied with their consultations and having their family history assessed. However, three issues were identified from the consultations which contributed to concerns and unanswered questions for patients. Problems arose when there were few modifiable risk factors to address. Firstly, patients' explanations of their family history were not explored in the consultation. Secondly, the relationship between the patient's family history and their other risk factors, such as smoking or cholesterol, was rarely discussed. Thirdly, clinicians did not explain the integration of family history into the patient's overall cardiovascular disease risk.
  
  
  CONCLUSIONS
  Clinicians appeared to lack a rhetoric to discuss family history, in terms of capturing both genetic and environmental factors and its relation to other risk factors. This created uncertainties for patients and carries potential clinical and social implications. There is a need for better guidance for primary care clinicians about family history assessment.
authors.affiliation: ESRC Centre for Genomics in Society, Byrne House, University of Exeter, Exeter, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.forename: Paula M
authors.initials: PM
authors.lastname: Saukko
authors.forename: Philip H
authors.initials: PH
authors.lastname: Evans
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
authors.forename: Steve E
authors.initials: SE
authors.lastname: Humphries
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000235:genetics / Q000517:prevention & control*; D004739:England; D005190:Family; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011322:Primary Prevention; D036301:Qualitative Research; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014741:Video Recording