Enhance Patient Engagement with Thorough Family Health History

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Specializes in Family Nurse Practitioner.

Nurses at all levels of practice are sometimes surprised to learn that a family health history is not just a tool for primary care providers, genetic counselors or family planning advocates. It’s a detailed record of the diseases and health conditions in a patient’s family that can serve as a foundation for healthcare decision making. When you begin to think of family health history as more than a non-modifiable risk factor for chronic disease, or a key component of a SOAP note, you can deliver truly patient-centered patient education, while supporting patient engagement.

The more details you know about your patient, the better the quality of your patient education. When you can speak to the patient’s personal experience, you can make any type of health-related education relevant to their individual situation. By encouraging patients to gather the information for a complete family health history, you’re empowering them to have health-related conversations with their families in a way that requires them to engage with their health outside the healthcare setting.

More than just genetics

It can be tempting to think of family health history as being synonymous with genetic variations and mutations, but health histories are more than just genetics. Family health history also encapsulates shared behaviors, cultural practices, and the patient’s living and working environment. These epigenetic factors influence health directly and indirectly and may contribute more to long-term health outcomes than other factors. Indeed, they open the door to revealing the consequences of lifestyle choices.

Risk is not reality

Family history points to risk, not reality, nor is it a guarantee of outcome. In other words, a family history of a specific disease does not necessarily mean an individual will also have the disease. Family health histories reveal risks in a way that opens the door to prevention and proactive action steps. Once that door is open, you can help your patient guide and direct their lifestyle changes and intervention options.

Patients’ interests and questions

While some patients may be interested in family histories thanks to the growing popularity of direct-to-consumer genetic testing, others may be fearful, skeptical, or reluctant to explore their family health history. In its most basic form, a family health history does not involve genetic testing. If genetic testing or counseling is medically indicated, it can be ordered and does not have to be direct-to-consumer. A basic family health history begins with information gathering. Vital information to gather (in writing) includes: information on ethnic background; major medical conditions; age at diagnosis and death; and cause of death for parents, grandparents, siblings, half-siblings, aunts, uncles, nieces, nephews and children.

Action and engagement

Once a basic family health history has been gathered, there are many ways to take action. For example, providers may order more frequent or earlier-than-recommended screenings or preventive medication. And, since most patients will have a family history of at least one chronic condition, lifestyle change and better-informed patient choices are likely to be indicated.

The most significant action steps nurses can take involve empowering patients to start conversations with their families at home about health history, and pointing them to useful (free) tools and resources. Here are some ideas to get started:

For patients who might be interested, but don’t know where to begin, the tool, “Does it run in the family?” can be a great conversation starter.
The Surgeon General’s “My Family Health Portrait” is a great way to organize the information gathered.
Try gathering family health history information yourself and share your experiences with your patients.
Encourage patients to engage with health history in ways that are relevant to their personal family situation. For example, young couples engaged in family planning are a natural fit for family health history discussions, while families with elders at home might try focusing a specific reminiscing session on health history.

Remember that by encouraging your patient to become interested in their own family health history, you are helping them engage with their health. Patients who embrace accountability, ownership, and engagement can be successful in making real and relevant lifestyle changes that lead to improved health outcomes. Patients with young families can influence the next generation, modeling lifestyle change and good habit-building for their children. And for you, as a nurse, when you serve more fully engaged patients who are more aware and interested in their health, you’ll likely feel more fulfilled in your work delivering quality care.

Your patients can’t change their past, their age, their race, or their ethnicity, but they can arm themselves with the powerfully preventive knowledge that comes from a thorough family health history. Gathering family health history data can motivate your patients to make lifestyle changes that set them up for a healthier, happier future.

Sources

Does it Run in the Family? Health History Tool

G2C2 – Genetics/Genomics Competency Center

Knowing is Not Enough—Act on Your Family Health History

My Family Health Portrait

Family Health History Day Social Media Toolkit - NIH National Human Genome Research Project

Family Health History

Family Health History and Chronic Disease

Family Health History is a Non-modifiable Risk Factor – Or Is It?

What is direct-to-consumer genetic testing?

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ChrisRN0529

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Jan 29, 2019

Hi, great article! I'm currently a FNP student and I have an assignment to interview an APN leader (simple questions). I was wondering if you would be willing to let me interview you via phone or email. If you are interest please email me at [email protected]. I would greatly appreciate it. Thanks a bunch.