Research identified demographic subgroups of patients whose family history information (FHI) may be incomplete, potentially compromising the effectiveness of clinical decision support tools in cancer care. The study findings were recently reported in the journal JAMA Network Open.

Clinical decision support tools are increasingly used for providing specialty care to patients, and while such tools can expand patient access to programs, some evidence suggests they may exacerbate unfair or biased practices. Since clinical decision support tools rely heavily on FHI, the researchers sought to evaluate disparities in FHI in electronic health records (EHRs) from 2 US healthcare systems.

The retrospective study examined EHRs from the University of Utah Health (UHealth) and New York University Langone Health (NYULH) systems. The researchers included patients who were aged 25 to 60 years and who had had any primary care appointments within these systems during the prior 3 years. Availability and comprehensiveness of FHI in patient EHRs were the primary metrics evaluated.

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Evidence of collection of any FHI, well as family cancer history, was the primary information the researchers used to define availability at the patient level. Comprehensiveness was evaluated based on whether cancer FHI included details about a family member’s cancer type, the relationship to the patient, and the age at diagnosis. The researchers evaluated FHI details across categories of sex, race, Hispanic or Latino ethnicity, and language preference.

The analysis included EHRs for 144,484 patients in the UHealth system and 377,621 patients in the NYULH system. Among patients in both systems, there appeared to be significant differences in the availability of any FHI and cancer FHI across multiple patient subgroups.

By race, cancer FHI availability was highest for White patients in both systems. In the UHealth system, it was lowest for Black patients, and in the NYULH system, it was lowest for Native Hawaiian and other Pacific Islander patients.

In both systems, Hispanic or Latino patients were less likely than non-Hispanic or non-Latino patients to have available cancer FHI, and Spanish-speaking patients were less likely than English-speaking patients to have available cancer FHI.

By sex, men were less likely to have available cancer FHI than women. Cancer FHI comprehensiveness also appeared to differ across the demographic subgroups.

These findings suggest that important differences in family cancer history availability and comprehensiveness are aligned by sex, race, ethnicity, and language preference. “Such differences may exacerbate disparities in the identification of patients who require specialty services or tailored disease screening recommendations,” the researchers concluded in their report.

“Efforts are particularly needed to improve availability and comprehensiveness of FHI for Black, Hispanic or Latino, Spanish-speaking, and male patients to mitigate the risk of health inequalities associated with these digital innovations.”


Chavez-Yenter D, Goodman MS, Chen Y, et al. Association of disparities in family history and family cancer history in the electronic health record with sex, race, Hispanic or Latino ethnicity, and language preference in 2 large US health care systems. JAMA Netw Open. 2022;5(10):e2234574. doi:10.1001/jamanetworkopen.2022.34574