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Assessment of Family History of Colorectal Cancer
Background


Oncology healthcare practitioners (HCPs) have become increasingly aware of the role genetics plays in the development of some cancers, including colorectal cancer (CRC). Family history is the first genetic screening. A positive family history of colon cancer or pre-cancerous adenomatous polyps is a known risk factor for the development of CRC. Although the majority of people who develop CRC have no family history of the disease, approximately 20% do have a family history (American Cancer Society, 2011).


Two nursing journals have recently published articles of interest for oncology HCPs who work in the areas of cancer prevention, genetic screening and counseling or the care of patients with CRC. One is a nursing research report and the other is a case-based presentation on the management of patients with a hereditary cancer syndrome.


Kelly (2011) reports on the accuracy of a family history assessment for CRC in three outpatient gastroenterology units and examines gastroenterology unit nurses’ knowledge and attitudes about family history assessments. Medical records of 88 colonoscopy procedures were surveyed using a researcher-developed tool, and 16 gastroenterology unit RNs were interviewed. Variables included type of cancer, age at disease onset, family relationship, and number of family members with cancer. Gastroenterology unit nurses were interviewed to assess knowledge and attitudes about family history assessment regarding CRC (Kelly, 2011).


Findings indicate that limited family history documentation was present in the medical record and that important age-at-disease-onset information was missing in 95% of patients with a family history of colorectal cancer and in 85% of patients with a family history of Lynch syndrome-associated cancers. No documentation was found in any charts about the number of affected relatives within the same family. Inconsistencies in family history documentation within the same medical record were noted, and family history information was found in multiple chart forms. Gastroenterology nurses rated family history as very important but gave a lower rating to personal knowledge about and resources for family history assessment (Kelly, 2011).


Kelly (2011) noted that patients expect and deserve genomically competent care and effective electronic health record (EHR) systems that support family history assessment and documentation. She concluded that research is needed on the optimal approaches to improve family history assessment in a variety of settings, not just in the gastroenterology unit. The research should evaluate patient family history reporting strategies or questionnaires, identify barriers to family history assessment, explore processes for confirming family history information, and target EHR improvements. She also noted that nurses have tremendous opportunities to be innovative leaders in family history assessment. Identifying family history assessment documentation and knowl¬edge gaps are the first steps toward improving practice.


Mahon (2011) presents two cases that demonstrate the complexities of providing and coordinating care for at-risk relatives with a genetic predisposition to developing cancer. When genetic testing is not carried out by a genetics professional, a great concern arises that other family members may not be informed of the risk of potentially deadly diseases that may be prevented with aggressive screening and surgical prophylaxis. Inherent in the responsibility of ordering a genetic test is the awareness that at-risk family members need to be contacted. Identification of at-risk family members is based on a three generation pedigree followed up with coordinated care for the family (Mahon, 2011).


Mahon (2011) noted that patients expect oncology nurses to play a role in risk identification and, in many cases, to provide and support a genetics referral. In addition, patients will need ongoing support after receiving genetic test results. When oncology nurses identify patients with possible genetic risk, they must reinforce the fact that other family members may have increased risk as well and assist the patient and family in obtaining comprehensive genetic care.


ManageCRC.com Commentary


Oncology interweaves genetics into prevention, diagnosis and treatment on a routine basis. Genetic tests are now routinely ordered to determine risk for developing and appropriate management of many hereditary cancer syndromes. Where oncology HCPs fail their patients is by ordering these tests without formal genetic assessment by a credentialed professional. In these two articles we find patients in one setting were not properly screened for family cancer history and an excellent case for consulting a credentialed genetics counselor when working with patients who relate a family history of cancer. The family history affects not only the patient being assessed, but also the family members who may be at risk. It is our responsibility – as oncology HCPs – to provide the level of expert care needed by patients and family members at risk. By doing it right, we not only serve our patients and families well, but we contribute to the genetics body of knowledge.


References


American Cancer Society. (2011). What are the risk factors for colorectal cancer? Retrieved from http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-risk-factors


Kelly, P.P. (2011). Colorectal cancer family history assessment: Documentation, deficiencies, and future directions. Clinical Journal of Oncology Nursing, 15, E75-E82. doi: 10.1188/11.CJON.E75-E82 Link to abstract http://ons.metapress.com/content/d01k4u15p2257404/?p=8546eb638e474f909caf636430e2fa0a&pi=3


Mahon, S.M. (2011). Managing families with a hereditary cancer syndrome. Oncology Nursing Forum, 38, 641-644. doi:10.1188/11.ONF.641-644  Link to abstract http://ons.metapress.com/content/334367001607231k/?p=78e4f66d9bf5468da7e807f90be39770&pi=11 


Article Created On : 11/10/2011 1:54:10 PM             Article Updated On : 11/10/2011 1:54:10 PM