The Importance of Family History in a Healthcare Student’s Education
The area of genetics and genomics might seem unusual for us to be discussing in our St. Vincent’s College blog. However, we wanted to tell you more about why taking a family history for a patient is such a valuable tool for healthcare professionals.I am writing this blog to share with our current and prospective students the importance of their education in this area. At St. Vincent’s College, our students in nursing, radiography and medical assisting are all taught the importance of taking a good family history. Students who take the Cancer Survivorship course are taught that it can save family members’ lives. They see how it is utilized in the Elizabeth M. Pfriem SWIM Center for Cancer Care.The Connecticut Department of Health has received a grant from the Center for Disease Control and Prevention for Education, Surveillance and Policy Efforts to Advance Cancer Genomic Best Practices in Connecticut. St. Vincent’s College RN to BSN students will help to initiate a model strategy to provide Family Health History information and outreach in a Community Health Center as part of this grant.
Teaching About Genetics at St. Vincent’s College
There is a wonderful article, if you are interested, on the topic in Nursing Outlook, January 2010: “Nurses transforming health care using genetics and genomics.” The basic thesis is that nurses are well positioned to incorporate genetic and genomic information across all aspects of the United States healthcare system.Genetics and genomics are applicable to the entire spectrum of healthcare. The majority of disease risk, health conditions and the therapies used to treat those conditions have a genetic and/or genomic element influenced by environmental, lifestyle, and other factors. Nurses must understand how to include knowledge of the patient’s and family’s history combined with their nursing experience with genetic/genomic technologies and information. In their roles they will have to guide patients to the right course of care when something has been discovered in their genetic assessment.
The Importance of the Family History for Diagnosing Disease
Among medical specialties, medical genetics is distinctive in that it focuses not only on the patient but also on the entire family. The late Barton Childs, a noted geneticist stated succinctly that: “to fail to take a good family history is bad medicine.”The American Medical Association has stated that the family tree has become the most important genetic test of all and is the first line of action.Even with the advent of cytogenetic, molecular and genome testing, an accurate family history and pedigree still remains a fundamental tool for genetic counselors and physicians to use for determining the pattern of inheritance of a disorder in the family. That family history is very important in forming a differential diagnosis, determining what genetic testing is needed and designing an individualized management and treatment plan for the patient. This is the process that is leading to the future of personalized medicine.Further and very importantly, the recognition of a genetic component in a disease allows the risk in other members of the family to be considered so that proper management, prevention and counseling can be offered to the patient and to the family.
Innovative Hereditary Risk Assessment at St. Vincent’s Medical Center
A program in Hereditary Risk Assessment was developed in the Cancer Center of St. Vincent’s Medical Center. It is currently staffed by a genetic counselor, an APRN and a physician. A family history and screening questionnaire, developed by the team, is used to review a patient to see if he or she qualifies for a risk assessment and a detailed family history pedigree. The team also receives referrals from physicians at St. Vincent’s Medical Center and in the community. It is important to note that most cancers are sporadic. These cancers occur by chance. People with sporadic cancers typically do not have relatives with the same type of cancer.Some cancers are familial. These cancers are caused by a combination of genetic and environmental risk factors. People with familial cancer may have one or more relatives with the same type of cancer. However, there does not appear to be a specific pattern of inheritance.Hereditary cancer occurs in 5% to 10% of all cancers. This type of cancer occurs when a mutated gene is passed down in the family from parent to child. People with hereditary cancer are more likely to have relatives with the same type or a related type of cancer. They may develop more than one cancer and their cancer often occurs at an earlier-than-the-average age than is seen in patients with the specific disease.The majority of hereditary cancers are inherited in the autosomal dominant mode of inheritance. This means that if a parent has the gene it will be passed on 50% of the time with each and every pregnancy.If the screening is for Hereditary Breast and Ovarian Syndrome (HBOC), which is an inherited condition, and usually caused by a mutation in the BRCA1 or BRCA2 genes, the patient has an increased risk of developing breast and ovarian cancer. Those same patients also have an increased risk for the development of pancreatic and prostate cancer.
Why Nursing Students Need to Know About Genetics and Genomics
In order for people to benefit from widespread genetic/genomic discoveries, nurses must be able to obtain comprehensive family histories. They must also look for family members at risk for developing a genomic-influenced condition. There are also genomic-influenced drug reactions to be aware of.Overall, nurses must help people make informed decisions about and understand the results of their genetic/genomic tests and therapies. At times they will have to know where and how to refer at-risk people to appropriate healthcare professionals and agencies for specialized care.Susan R. Capasso, Professor/Vice President Academic Affairs/Dean of Faculty at St. Vincent’s College also serves as a Genetic Counselor at St. Vincent’s Medical Center
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Topics: Nursing Careers