Rethinking the ‘family’ approach: the case of coronary heart disease prevention
SpeakersDr Hannah Farrimond, Egenis Research Fellow
GF7, Byrne House
Time: 3:30 PM - 5:00 PM
Event detailsAs the ‘preventive’ health-care agenda takes shape within the NHS, but genetic susceptibility testing for common and complex disease seems far off, many policy-makers have advocated using family history approaches to identify and treat ‘high risk’ patients before they become ill. This presentation considers risk screening for coronary heart disease as an exemplar of this approach, using data drawn from the ADDFAM study (Adding Family History to Coronary Heart Disease Risk Assessments). The quantitative randomised controlled trial (n=700) of risk assessments and intervention, half with family histories included, is still ongoing. The RCT is complemented by a qualitative nested study of ‘discovery’ type interviews with patients (conducted two weeks and six months after intervention) plus focus groups with GPs. The results are presented here are drawn from the two week patient interviews with 38 ‘high risk’ participants (average age 58 years). It is suggested that after the initial shock of being identified as ‘high risk’, patients found themselves with a ‘liminal’ state of identity (Scott et al. 2005) in which their sense of being ‘at risk’ fluctuated. Many minimised their personal vulnerability by making downward social comparisons, identifying ‘others’ as less healthy as themselves. Their sense of ‘being at risk’ was also mitigated by social context, particularly relating to age and life-stage; being at risk of heart disease was understood as a normal part of the aging process. Lifestyles were also very entrenched and many participants had co-morbidities which they perceived made lifestyle change more difficult. Being ‘high risk’ was less shocking for those with a positive family history of premature heart disease. They understood their family history, not just in the context of a multiplicity of other risk factors, but within a personal, historical and socio-economic context. It is unclear, however, whether it was motivating in terms of behaviour change. There are several policy implications. One is that family histories should be used systematically, as with diabetes, to target risk assessments to ‘high risk’ groups. The second is that lifestyle advice should be very specific to encourage change in this age group. The third is that prevention should also target younger age groups (35-50 years) with family histories who are the potential ‘high risk’ patients of the future and for whom the potential for change may be greater. Finally, the future research agenda for family history approaches within the genomic era is considered.