doi:10.1093/fampra/cmm037 Family Practice Advance Access published on 28 August 2007 Assessing family history of heart disease in primary care consultations: a qualitative study

Background. Current primary prevention guidelines recommend the assessment of family his-tory of coronary heart disease (CHD) to identify at-risk individuals. Objective. To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care. Methods. A qualitative study. Patients completed a validated family history questionnaire. Con-sultations with clinicians were video recorded, and semi-structured interviews conducted with patients after consultation. The participants were 21 primary care patients and seven primary care clinicians (two practice nurses, five GPs). Four practices in South West England. Results. Patients and clinicians usually agreed about the patient’s level of risk and how to re-duce it. Patients were mostly satisfied with their consultations and having their family history as-sessed. However, three issues were identified from the consultations which contributed to concerns and unanswered questions for patients. Problems arose when there were few modifi-able risk factors to address. Firstly, patients ’ explanations of their family history were not ex-plored in the consultation. Secondly, the relationship between the patient’s family history and their other risk factors, such as smoking or cholesterol, was rarely discussed. Thirdly, clinician