title: Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr).
abstract: OBJECTIVE
  This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history.
  
  
  METHODS
  A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6month follow-up, adjusting for age, site and practice clustering.
  
  
  RESULTS
  A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's<.01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not. Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases.
  
  
  CONCLUSIONS
  Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, USA. Electronic address: clwang@bu.edu.
authors.forename: Catharine
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Plegue
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Mack T
authors.initials: MT
authors.lastname: Ruffin
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, USA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: O'Neill
authors.affiliation: National Center for Biotechnology Information, National Institutes of Health, Bethesda, USA.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Rubinstein
authors.affiliation: Departments of Family Medicine & Community Health and Reproductive Biology, Case Western Reserve University and Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, USA.
authors.forename: Louise S
authors.initials: LS
authors.lastname: Acheson
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002487:Centers for Disease Control and Prevention, U.S.; D016000:Cluster Analysis; D003142:Communication; D005190:Family; D005192:Family Health; D005260:Female; D015438:Health Behavior; D006282:Health Personnel; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D018570:Risk Assessment / Q000379:methods; D012984:Software; D014481:United States
keywords: Chronic disease; Dose effects; Family communication; Family history assessment; Provider communication