Nurses at Des Peres Hospital, Des Peres, MO, consider family health history data so important they encourage patients and visitors to click on a link on the hospital website that takes them to My Family Health Portrait, a risk evaluation tool sponsored by the U.S. Department of Health and Human Services.
"We review family histories to help risk-stratify our patients for diseases like congestive heart failure, acute coronary syndrome, diabetes, hypertension, ovarian cancer or breast cancer," explained educator Theresa Canania, RN.
"Once we have a good picture of family history, we know how strongly to recommend interventions like smoking cessation, exercise classes and dietary modifications. Family histories also give use important clues about the need for diagnostic tests such as mammograms or colonoscopies."
Digging a Little Deeper
While tools like My Family Health Portrait offer a good starting point for a discussion about disease risks, nurses need to gather more data to clarify the picture.
"A lot of people don't know all the information about their family, or they don't really know the correct name for a condition or disease," Canania noted. "Nurses can ask knowledgeable questions, such as 'did she have chemotherapy or radiation therapy for her cancer?' to help sort it out."
Des Peres nurses incorporate plenty of patient and family education into their everyday practice. "Physicians rely on us to help identify risks from the family health history and share important findings with them," Canania said.
NICU nurses at Duke University Hospital, Durham, NC, pay close attention to family history information recorded during the mother's prenatal visits and gather additional data as needed.
"We're looking for any genetic disorders that may be passed down on either mom or dad's side of the family," said Amy Yancy-Magnum, MSN, NNP-BC, director of advanced clinical practice for women's and children's services. "These include cystic fibrosis and sickle cell disease, especially in the African-American population. Some forms of Down syndrome and a number of inherited metabolic disorders can also impact the baby's health."
Yancy-Magnum noted that both prenatal history and family history can provide important clues about factors affecting the wellbeing of newborns.
"We need to know if mom has been diagnosed with a condition that could have impacted fetal growth and development," she explained. "When mom has a heart defect, we'll watch for signs and symptoms of congenital heart defect in the neonate as well."
Decisions About Cancer
When women come to Newton-Wellesley Hospital in Newton, MA for a mammogram, the technician asks pertinent questions about their family history of cancer and enters the data into the computer.
Women with follow-up appointments at the Auerbach Breast Center answer more detailed questions on a tablet computer.
Nurse practitioner Dana Dowd, MS, RN, WHNP, meets individually with high-risk patients to tease out more clues that can stratify the risk picture.
"We may know that someone in the family has been diagnosed with breast cancer, but we need more specific information," she said. "We know, for example that hereditary forms of breast and ovarian cancer are usually diagnosed in younger women, so I'll ask what type of cancer the family member had and when she received her diagnosis."
After the discussion, Dowd recommends annual visits for high-risk women. "Family histories are dynamic and a lot can change in a year, so I ask if there's been any change in family members," she explained. "We may start doing MRIs in addition to mammograms, offer estrogen-blocking agents or just recommend more frequent breast exams."
Dowd wants to clear up a common misconception that paternal history doesn't influence cancer risk. "We get half of our genes from our mothers and half from our fathers, so the paternal side is equally important when we're evaluating cancer risks," she said.
Women who test positive for BRCA genetic mutations learn they're at higher risk for recurrent breast cancer as well as ovarian cancer.
"They may want to have both breasts and both ovaries removed," said Cathy Conner, BSN, RN, breast cancer patient navigator at Flagler Hospital, St. Augustine, FL. "The problem is there are still a lot of genetic mutations we don't know about yet, so women with a strong family history of breast cancer but negative BRCA results may still want to do what they can prophylactically. Some women have gone through years of mammograms and biopsies, and they just want to be done."
"For young women who test positive for genetic markers like BRCA mutations, the decision to have both ovaries removed has significant consequences," Conner continued. "The surgery will throw them into early menopause and it won't be easy for them to bear children."
A Family Affair
Nancy Moore, RN, CET, a staff nurse and coordinator of EECP [enhanced external counterpulsation] at Shady Grove Adventist Hospital's Cardiac Rehab Center, Rockville, MD, incorporates family health histories into the treatment plan for each participant.
"We individualize each person's exercise program and teaching plan based on what we learn during our initial assessment," she explained. "When I teach about risk factors, I include a family history of cardiovascular disease, diabetes or stroke along with lifestyle choices such as smoking, poor nutrition, and lack of exercise."
Moore encourages family members to join cardiac rehab participants in the educational process. "If someone has a strong family history of diabetes, for example, I tell them how that history will affect their own health and the health of their children," she said.
"We see a lot of people in their 40s and 50s, and emphasize to them that making healthy lifestyle changes will benefit the entire family. I remind them that exercise isn't limited to a treadmill or other equipment, and suggest they involve other family members in a weekend hike, biking or canoeing. We encourage spouses and older children to attend our educational programs, yoga classes, and holiday dinners where we serve healthy foods."
Sandy Keefe is a frequent contributor to ADVANCE.