George Washington University Hospital Washington, DC
Introduction: Obtaining a complete family history (FH) informs gastrointestinal (GI) cancer screening and referrals for genetic testing, but this is inconsistently done during colorectal cancer (CRC) screening visits. Previously, we improved the rate of complete FHs obtained to 28.4% from 5.2% after implementing education and a FH screening form in clinic. In this study, we assessed the impact of sharing a FH dot phrase on the rate of complete FHs obtained and genetics referrals made during outpatient CRC screening visits.
Methods: We shared a dot phrase that prompts obtaining a complete FH to our gastroenterology division on February 9, 2022. A complete FH was defined as addressing history of cancer in first- and second-degree relatives, colon polyps in first-degree relatives, and GI disease. We reviewed outpatient GI CRC screening visits from February 10, 2022 to March 9, 2022, and compared them to a one-month period of pre-intervention visits. Patient characteristics, rates of complete FH and genetic referrals were extracted. Patients with prior colonoscopies or indications for diagnostic colonoscopy were excluded. Rates of complete FH and genetic referrals were compared between the pre- and post-intervention groups with unpaired T-tests.
Results: A total of 188 patient visits were included; 93 post-intervention and 81 pre-intervention. The pre-and post-intervention groups were overall similar, but there were more white patients in the post-intervention group (Table 1). Complete FHs were obtained in 46/93 (49.5%) of post-intervention visits compared to 23/81 (28.4%) of visits in the pre-intervention group (p = 0.004). Genetic referrals were placed in 1/93 (1.1%) of post-intervention visits compared to 3/81 (3.7%) of pre-intervention visits (p=0.270).
Discussion: In our study, the rate of complete FHs obtained increased significantly to 49.5% from 28.4% after introduction of a FH dot phrase . The rate of genetic referrals was unchanged, though a larger sample size may be required to detect any potential difference. Given there were more white patients in the post-intervention group, further observation of complete FH rates in patients based on race is warranted. When upper GI problems were addressed along with CRC screening, FHs were often incomplete, suggesting a target for further intervention. Overall, further efforts are warranted to increase the rate of complete FHs obtained during CRC screening visits.
