The Cultural Genogram Raising Awareness of the Impact

The Cultural Genogram: Raising Awareness of the Impact of Cultural Factors on Health Outcomes David Henderson, MD Predoctora. L Director Assistant Professor Kenia Mansilla-Rivera, MD Assistant Professor University of Connecticut School Of Medicine

Goals and Objectives To recognize the value of the cultural genogram as an educational tool to enhance cultural sensitivity among undergraduate medical students. We will: n n Describe the features unique to cultural genograms useful for the documentation of sociocultural information Describe the use of the cultural genogram to enhance students’ communication skills in cross cultural situations across a spectrum of undergraduate medical curricular activities

Goals and Objectives To recognize the role of the cultural genogram as an educational tool to increase awareness of factors that contribute to healthcare disparities. We will: n Describe the capacity of a cultural genogram to depict the interaction between sociocultural and environmental factors, and biogenetic predispositions in determining health outcomes n Identify the utility of an electronic cultural genogram as an integrated part of electronic health records (EHR) n Identify strategies for utilizing a cultural genogram to enhance the teaching and practice of culturally appropriate, patient centered care

Session Content n n n n Introduction and Poll of Audience Rationale Overview of Orientation Collaboration with Genoware, Inc. ™ Home Visit Genograms Genogram and m. EMR_e Discussion of barriers and future possibilities

The Cultural Genogram n Poll of Audience • Standardized family curriculum • Primary care genetics/genomics curricular components • Prior/current use of genogram n Biomedical information n Social/Family History

Wherefore the Cultural Genogram? n n Ideal format for display of both FH and SH Patterns of disease and behavior are more easily elucidated in graphic display Graphically representation of the interplay between biology and environment 3 generational history is most valid

Focus on the Family n Genograms • Are inherently family centric • Family-centric model of care n Cultural Genograms • Blend biomedical and social information • Soften the sharp edge of genetics • Promotes integrated view of risk factors and health outcomes

Family-Centric Model of Care n The Influence of Family on Culture • Social Environment § § § Shared relationships, belief systems, behavior Ethnically derived customs Socioeconomic status • Physical Environment § § Household Neighborhood

Family-Centric Model of Care n The Influence of Family on Health • Family contributes genetic and biological factors • Up to 26% of variance in individual health status is related to family factors • Concordance between spouses for asthma, depression, suicide, dyslipidemia, CAD, HTN, PUD • Family is more influential the longer people are living together

Genogram in Course Orientation n Role of Family in Culture n Simpson Genogram Demo n Paired Genogram Development

Simpson Genogram

Collaboration with Genoware, inc.

Home Visit Experience n n n Students do a write up about the experience. They include the patient medical information, as well as family, social and cultural factors, and how they affect their health. They include their preconceptions, and their plans for changes in the patient’s care. Students build a genogram with the information obtained. Write ups are posted on a web based “chat”, where students read and comment on each other’s assignment.

Home Visit Example 1 n n …Two days later I went to visit him in the hospital and the first thing he said to me was “you’re the doctor who prayed for me and saved my life”… …He grew up in a Catholic church and described his parents as very religious people. He finished 7 th grade and went to work in a carpet rug factory at the tender age of 13 to help out his family. His father died when he was 17… … He began to tell me how his family had deserted him, and the only person he talks to is God… … I went to that house expecting to see the jovial, sweet, and kindhearted Hispanic man I saw in the clinic, surrounded by grandchildren and a family. Instead I met this lonely, hardworking, respectful, pleasant man who is rejected by his family and who now has to do everything himself.

Home Visit Example 1

Home Visit Example 2 n n n …We went to the home of a patient who was in an MVA 25 yrs ago…. . and has been in a vegetative state since … …Once, the brother had the choice to take the patient off the ventilator… He chose not to because, he feels it is not his place to end a life …If you look around the house and outside, there are religious symbols everywhere …I also assumed that there would be some sort of VNA services …The actual medical care of the patient, between the doctor and the family, is excellent. He has only had one pressure ulcer in his life and rarely has to be hospitalized. It is the care of the family that I would focus on …

Home Visit Example 2

m. EMR_e

Mc. Q Genogram

Jane’s Visit

Gene Reviews

Fragile X

Gene. Reviews

Mary’s Visit

Genetic Tools

Genetic Tools

Genetic Tools

Starting Mc. Q Genogram

Final Mc. Q Genogram

Pretest Student Name: ____________ New MAX Survey Questions for Genogram How often have you used genograms in a clinical setting? Very Infrequently 1 2 Occasionally 3 4 Very Frequently 5 How valuable are genograms as a tool for the documentation of sociocultural information? Not at all Valuable 1 2 Moderately Valuable 3 4 Very Valuable 5 How valuable are genograms as a tool for linking medical and sociocultural information? Not at all Valuable 1 2 Moderately Valuable 3 4 Very Valuable 5

Post Test Student Name: ____________ New MAX Survey Questions for Genogram What is the value of genograms in a clinical setting? Not at all Valuable 1 2 Moderately Valuable 3 4 Very Valuable 5 How valuable are genograms as a tool for the documentation of sociocultural information? Not at all Valuable 1 2 Moderately Valuable 3 4 Very Valuable 5 How valuable are genograms as a tool for linking medical and sociocultural information? Not at all Valuable 1 2 Moderately Valuable 3 4 Very Valuable 5

Barriers n Process – related • Time issues • Structured integration in small group setting n Data Collection

Discussion n n Genogram vs. Cultural Genogram Primary Care Genetics/Genomics and Cultural Genograms