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Integration of family health history in clinical guidelines for breast, ovarian, and colorectal cancer

Collier, Ashley
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337350837

Abstract Details

2012, MS, University of Cincinnati, Medicine: Genetic Counseling.
Introduction: Family health history (FHH) is clinically useful in identifying individuals at increased risk for chronic diseases such as cancer. In this study, we assessed inclusion of FHH and genetic testing, as well as FHH integration, into counseling (patient education and psychosocial support), prevention, risk assessment, and screening guidelines for breast, ovarian, and colorectal cancer. We determined the proportion of guidelines that included FHH, genetic testing, and integrated FHH. Methods: We used the National Guideline Clearinghouse (NGC), an online, public database of clinical practice guidelines, to identify guidelines that addressed counseling, prevention, risk assessment, and/or screening for breast, ovarian, and colorectal cancer. These guidelines were coded to determine the inclusion of FHH, genetic testing, and FHH integration. FHH was coded as “well-integrated” if the guideline included all three of the following points: defined FHH in terms of familial relationship, utilized FHH to stratify risk of developing disease, and utilized FHH to recommend modified medical management. Results: 65 guidelines met inclusion/exclusion criteria (23 breast cancer, 18 colorectal cancer, four ovarian cancer, and 20 for multiple conditions). FHH was included in 46 guidelines (71%). FHH was defined with respect to familial relationship (such as first-, second-, or third-degree relative with cancer) in 26 guidelines (40%). Diagnostic genetic testing was included in 23 guidelines (35%). Colorectal cancer guidelines referenced diagnostic genetic testing in the highest proportion of guidelines (10 of the 18 colorectal cancer guidelines; 56%) and referenced a specific diagnostic genetic test in the highest proportion of guidelines (8 of the 18 colorectal cancer guidelines; 44%). FHH was well-integrated into 15 guidelines (23%). Surprisingly, 19 (29%) did not include FHH at all, and five (8%) included FHH but did not include any of the above points listed for measuring FHH integration. In the remaining 26 guidelines, only one or two of the three above points were included. FHH was well-integrated into the highest proportion of colorectal cancer guidelines (50%) and the lowest proportion of breast cancer guidelines (13%). Conclusions: This study raises awareness of the deficits of FHH integration into clinical practice guidelines for breast, ovarian and colorectal cancer. Despite being a useful tool to identify individuals at increased risk for disease who might benefit from counseling (including patient education and psychosocial guidance), risk assessment, genetic testing, and earlier or different screening/management for disease detection or prevention, FHH was not well-integrated into most guidelines. Better integration of FHH into clinical practice guidelines will help practitioners identify and manage individuals at increased risk for disease, and may result in prevention or early detection of disease.
Melanie Myers, PhD (Committee Chair)
Carlos Prada, MD (Committee Member)
39 p.
Public Health
Breast Cancer; Ovarian Cancer; Colorectal Cancer; Clinical Guidelines; Family History; ;

Recommended Citations

Citations

  • Collier, A. (2012). Integration of family health history in clinical guidelines for breast, ovarian, and colorectal cancer [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337350837

    APA Style (7th edition)

  • Collier, Ashley. Integration of family health history in clinical guidelines for breast, ovarian, and colorectal cancer. 2012. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337350837.

    MLA Style (8th edition)

  • Collier, Ashley. "Integration of family health history in clinical guidelines for breast, ovarian, and colorectal cancer." Master's thesis, University of Cincinnati, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337350837

    Chicago Manual of Style (17th edition)

ucin1337350837
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© 2012, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.