‘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