Step 4: Select a family history assessment tool and develop a process for its use

This section covers the following steps:

Step 4.1 Select which family history tool your practice will use

Step 4.2 Ensure your clinical team has the skills and resources they need to undertake detailed family history assessments

The use of a simple family history screening questionnaire (FHSQ) can help identify individuals who require a more detailed assessment of their family history of cancer or other conditions.¹⁰

Success in practice:

‘Introducing a family history screening questionnaire’

“Participating in cancer screening quality improvement highlighted to me that our family history taking was incomplete. Many of my patients have been with me for a long time, but I had no systematic way of updating family history.

Just over two years ago, I decided to introduce a two-page questionnaire; the first page was the RACGP ‘Family history screening questionnaire’ and the second page was the RACGPs ‘Audit-C’ questionnaire for assessing alcohol consumption.

We gave this survey out to virtually every patient. It was an excellent tool for supporting conversations about family history and alcohol consumption. Alcohol is a major risk factor for many of my patients, but one that they don’t find easy to talk about.

As a result of our initial conversations, many patients had to go and find out more detail about their family history. Many knew someone had died prematurely or had a condition, but not the specifics. Patients have even come back to me with the death certificates of family members.

I have identified a few patients in their thirties and forties who needed to begin screening early in accordance with the guidelines for their specific familial risk. As a result of this, some patients with multiple polyps have been detected. Some of them were at a significantly increased risk of bowel cancer and this would have otherwise been missed.

I have several generations of the same family in my practice. The increased focus on family history has allowed me to better counsel and prepare patients in their 20’s who I know will need early screening. This also has given me the opportunity to encourage lifestyle changes which are needed to reduce their individual risks.

We now ask patients annually if anything has changed in their family history. If they say ‘yes’, we ask them to complete the survey again.

It does take time, but the opportunity to provide comprehensive and individualised care is a unique privilege of having a long-term relationship with the same family doctor. Over time, patients develop trust and this is vital to the therapeutic relationship which satisfies both the doctor and the patient.”

-- Dr Nandini Subbiah, Subbiah Family Practice, Port Macquarie, NSW

Step 4.1 Select which family history tool your practice will use

You can select from the following two tools, or develop your own method for identifying people who require a detailed familial risk assessment.

Option 1

The RACGP Family history screening questionnaire can be used as part of the person’s assessment at their first visit to a practice. 

• The tool identifies patients who need a more detailed assessment of their familial risk of cancer, heart disease or diabetes. A positive response to any question requires follow-up with a more detailed assessment of the family history.
• Given family history can change, it is recommended that the questionnaire be repeated at least every three years. 
• People with low health literacy may need support to complete the questionnaire.
• When available, an Aboriginal health worker can assist an Aboriginal or Torres Strait Islander person with the form, if needed.

Option 2

The ‘Cancer Screening Checklist’ for men and women prompts discussions about cancer screening and helps identify people who require a detailed family history assessment. 

The checklist is given out by reception staff to patients who meet eligibiligy criteria. The patient then takes the checklist into the GP who reviews the checklist with the patient and returns it to reception for further action, as required.

This document explains the ‘Cancer Screening Checklist’ workflow and eligibility criteria.

* The ‘Cancer Screening Checklist’ resources were developed by the Cancer Council SA and Country SA Primary Health Network and adapted with permission by Cancer Institute NSW.

Step 4.2 Ensure your clinical team has the skills and resources they need to undertake detailed family history assessments

Introducing the regular use of either the RACGP Family history screening questionnaire or the Cancer Screening Checklist will result in your clinical team identifying patients who require detailed family history assessment.

It is important that your clinical team:

• has the skills and information they need to complete family history assessments.
  • Consider conducting in-service training. Training information can be found at:
    • RACGP’s Genomics in general practice: Family history
    • Gen-Equip’s Taking and recording a family history

• uses a consistent approach to:
  • recording family histories in your practice software
  • ensuring appropriate clinical follow-up of patients found to have increased familial risk

Consider developing a policy or workflow for family history taking, and management of patients with increased familial risk.