MeTree in Singapore

Wednesday, March 11, 2020
By Alexis Kessenich

On average, a physician is only able to spend about 10-15 minutes with each patient, which doesn’t leave much time for any in-depth discussion, and important conversations like family health history often fall by the wayside. While discussing your family health history (FHH) might not seem like a top priority to you when visiting your physician, it can be an important factor in assessing risk and determining the best treatment plan for you.

Because of the importance of FHH, researchers in the Duke Center for Applied Genomics and Precision Medicine (CAGPM) designed MeTree, a patient-facing family health history-based risk assessment and clinical decision support system. MeTree was designed to overcome the major barriers to collecting and using high quality family health histories to guide clinical care. 

Last year, Ryanne Wu, M.D., assistant professor of medicine, and member of the MeTree team, returned from a three year stay in Singapore. While abroad, Wu took the opportunity to implement the MeTree platform through a large epidemiological study of whole genome sequencing. This gave her the opportunity to evaluate whether the quality of FHH information received from patients changed depending on the method in which it was collected.

She and her team investigated two groups of participants; the first was given a standard paper worksheet to complete and the second was given access to the software, MeTree. Participants were only told that they would be asked about their family’s health history. Wu wrote about the study’s findings in a paper which was recently published in Preventive Medicine Reports

Although the same number of relatives were entered by both groups of participants, those who used MeTree entered significantly more health information about their relatives, including disease types and age of onset of disease. They also had significantly more risks identified such as breast and colon cancers. “This is likely due to MeTree prompting users to provide additional information through its interactive nature,” Wu said. 

These findings are important because the level of detail of FHH data collected affects risk recommendations from a patient’s doctor. For example, it will be much simpler for a doctor to determine a patient’s risk of developing colon cancer and begin testing at an appropriate age if the doctor knows that their patient’s grandmother was diagnosed with the disease. These risks can be identified more easily with the use of applications like MeTree. 

“If you ask any patient or any doctor if family history matters, they’ll all say it does,” Wu said. “But then if you actually look at how it’s being used in a clinical setting, you’ll find it’s not being used in a way that has significant impact at a population level.” 

The ultimate goal for FHH, according to Wu, is “systematic risk assessments on all individuals with the goal of guiding clinical care.” This helps doctors to be able to translate risk into choices about your health. A doctor’s job is not to be a scribe and ask about every individual family member; it’s to help their patients live longer, healthier lives. To make the most out of the time given with doctors, applications like MeTree will help streamline care and provide better outcomes to patients.

CITATION: "Evaluation of family health history collection methods impact on data and risk assessment outcomes,” R. Ryanne Wu, Rehena Sultana, Yasmin Bylstra, Saumya Jamuar, Sonia Davila, Weng Khong Lim, Geoffrey S. Ginsburg, Lori A. Orlando, Khung Keong Yeo, Stuart A. Cook, Patrick Tan. Preventative Medicine Reports, March 5, 2020. DOI: 10.1016/j.pmedr.2020.101072