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Physicians Caring for Celiac Patients do not Routinely Recommend Screening of First-Degree Family Members
Abhik Roy1, Colin Smith1, Constantine Daskalakis2
1Department of Medicine, Thomas Jefferson University; 132 South 10th Street, Suite 480, Philadelphia, PA 19107, the United States.
Insights
Physicians often fail to recommend celiac disease (CD) screening for relatives of diagnosed patients. Increased physician recommendations for first-degree relative screening could significantly improve CD diagnosis rates in high-risk individuals.
Area of Science:
- Gastroenterology
- Genetics
- Public Health
Background:
- Screening first-degree relatives of celiac disease (CD) patients is crucial for early diagnosis in a high-risk population.
- Physician recommendations play a key role in initiating family screening for CD.
Purpose of the Study:
- To determine the frequency of physician-issued recommendations for first-degree relative screening among CD patients.
- To assess the impact of such recommendations on subsequent CD diagnosis in relatives.
Main Methods:
- A validated 12-question survey was administered to CD patients at a university gastroenterology practice and online to members of a celiac organization.
- Data from 677 NFCA and 82 University respondents were analyzed using univariate analysis.
Main Results:
- Only 44% of NFCA members and 78% of University patients received a physician recommendation for family screening.
- Recommendations led to family discussion, screening, and diagnosis in a significant proportion of cases (18-27% diagnosis rate).
Conclusions:
- Physician compliance with recommending first-degree relative screening for CD is often inadequate.
- Enhancing physician recommendations for screening can significantly increase CD diagnoses in at-risk family members.
Aim:
Screening first-degree relatives of celiac disease (CD) patients offers an opportunity to diagnose CD in a high-risk population.This study aims to determine how frequently CD patients receive a physician-issued recommendation for first-degree relative screening.
Materials And Methods:
A 12-question survey assessing whether CD patients receive a physician recommendation to screen first-degree relatives for CD, and the impact of such a recommendation, was validated with outpatients in a university gastroenterology practice ("University"). The 12-question survey was then distributed online to members of a celiac organization - the National Foundation for Celiac Awareness ("NFCA"). Results were collected over 3 months. Univariate analysis was used to compare cohort means and assess the association between demographic and diagnostic factors and first-degree relative screening recommendations.
Results:
87 University patients participated in the validation phase. Test-retest reliability of 4 key survey questions was high (Kappa coefficient > 0.80). The main analyses were based on data from 677 NFCA and 82 University respondents. Respondents were predominantly female, with a mean age of 45 years. Significantly more University patients received a recommendation for screening (78% vs 44%, p < 0.001). Ninety-eight percent receiving a screening recommendation (both groups) discussed this with family members, leading to CD screening (University 71%, NFCA 79%) and, ultimately, a CD diagnosis (University 18%, NFCA 27%).
Conclusions:
Physicians of CD patients often do not recommend screening first-degree family members. The high clinical impact of this recommendation suggests that greater physician compliance with screening may increase the diagnosis of CD in high risk individuals.
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