Open Access Research article

Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial

R Ryanne Wu124*, Lori A Orlando234, Tiffany L Himmel3, Adam H Buchanan5, Karen P Powell6, Elizabeth R Hauser78, Astrid B Agbaje9, Vincent C Henrich6 and Geoffrey S Ginsburg23

Author Affiliations

1 Health Services Research and Development, VA Health System, Durham, NC, USA

2 Duke Center for Personalized Medicine, Duke University, Durham, NC, USA

3 Institute of Genome Science & Policy, Duke University, Durham, NC, USA

4 Duke Department of Internal Medicine, Duke University Health System, Durham, NC, USA

5 Duke Cancer Institute, Duke University Health System, Durham, NC, USA

6 Center for Biotechnology, Genomics and Health Research, UNC-Greensboro, Greensboro, NC, USA

7 Center for Human Genetics, Duke University, Durham, NC, USA

8 Durham Epidemiologic Research and Information Center, VA Health System, Durham, NC, USA

9 Cone Health System, Greensboro, NC, USA

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BMC Family Practice 2013, 14:111  doi:10.1186/1471-2296-14-111

Published: 6 August 2013



Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree©, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree© into 2 primary care practices.


This was a Type 2 hybrid controlled implementation-effectiveness study in 3 community-based primary care clinics in Greensboro, NC. All non-adopted adult English speaking patients with upcoming routine appointments were invited. Patients were recruited from December 2009 to the present and followed for one year. Ease of integration of MeTree© into clinical practice at the two intervention clinics was evaluated through patient surveys after their appointment and at 3 months post-visit, and physician surveys 3 months after tool integration.


Total enrollment =1,184. Average time to complete MeTree© = 27 minutes. Patients found MeTree©: easy to use (93%), easy to understand (97%), useful (98%), raised awareness of disease risk (85%), and changed how they think about their health (86%). Of the 26% (N = 311) asking for assistance to complete the tool, age (65 sd 9.4 vs. 57 sd 11.8, p-value < 0.00) and large pedigree size (24.4 sd 9.81 vs. 22.2 sd 8.30, p-value < 0.00) were the only significant factors; 77% of those requiring assistance were over the age of 60. Providers (N = 14) found MeTree©: improved their practice (86%), improved their understanding of FHH (64%), made practice easier (79%), and worthy of recommending to their peers (93%).


Our study shows that MeTree© has broad acceptance and support from both patients and providers and can be implemented without disruption to workflow.

Family health history; Cancer screening; Clinical decision support; Health services