Assessing family history of heart disease in primary care consultations: a qualitative study

Area of Science:

• Cardiology
• Primary Care Medicine
• Health Communication

Background:

• Family history of coronary heart disease (CHD) is a key factor in primary prevention guidelines for identifying at-risk individuals.
• Current guidelines emphasize assessing family history for CHD risk.

Purpose of the Study:

• To investigate how clinicians and patients perceive and discuss family history within the context of CHD risk assessment in primary care settings.
• To identify communication gaps and patient concerns regarding family history assessment.

Main Methods:

• Qualitative study involving 21 primary care patients and 7 clinicians (GPs and practice nurses).
• Utilized validated family history questionnaires, video-recorded consultations, and post-consultation semi-structured interviews.
• Study conducted across four general practices in South West England.

Main Results:

• Patients and clinicians generally agreed on risk levels and reduction strategies, with most patients satisfied with the assessment.
• Identified three key issues: unexplored patient explanations of family history, infrequent discussion of the link between family history and other risk factors (e.g., smoking, cholesterol), and lack of explanation on integrating family history into overall cardiovascular risk.
• These issues led to patient concerns and unanswered questions, particularly when few modifiable risk factors were present.

Conclusions:

• Clinicians often lack effective communication strategies (rhetoric) to discuss family history, encompassing genetic and environmental influences and their relation to other risk factors.
• This communication gap creates patient uncertainty with potential clinical and social implications.
• There is a clear need for improved guidance and training for primary care clinicians on conducting comprehensive family history assessments.