title: Clinical utility of family history for cancer screening and referral in primary care: a report from the Family Healthware Impact Trial.
abstract: OBJECTIVE
  To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change.
  
  
  METHODS
  We conducted a randomized clinical trial in primary care patients aged 35-65 years using Family Healthware, a self-administered, internet-based tool that collects family history for six common diseases including breast cancer, colon cancer, and ovarian cancer, stratifies risk into three tiers, and provides tailored prevention messages. Cancer screening adherence and consultation were measured at baseline and 6-month follow-up.
  
  
  RESULTS
  Of 3283 participants, 34% were at strong or moderate risk of at least one of the cancers. Family Healthware identified additional participants for whom earlier screening (colon cancer, 4.4%; breast cancer, women ages: 35-39 years, 9%) or genetic assessment (colon cancer, 2.5%; breast cancer, 10%; and ovarian cancer, 4%) may be indicated. Fewer than half were already adherent with risk-based screening. Screening adherence improved for all risk categories with no difference between intervention and control groups. Consultation with specialists did not differ between groups.
  
  
  CONCLUSIONS
  Family Healthware identified patients for intensified cancer prevention. Engagement of clinicians and patients, integration with clinical decision support, and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment.
authors.affiliation: Department of Medicine, Division of Genetics, NorthShore University HealthSystem, Evanston, Illinois 60201, USA. wrubinstein@northshore.org
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Rubinstein
authors.forename: Louise S
authors.initials: LS
authors.lastname: Acheson
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: O'Neill
authors.forename: Mack T
authors.initials: MT
authors.lastname: Ruffin
authors.forename: Catharine
authors.initials: C
authors.lastname: Wang
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.forename: Nan
authors.initials: N
authors.lastname: Rothrock
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005192:Family Health; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012984:Software; D011795:Surveys and Questionnaires
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