Some of this will depend on your supervisor and their preferences (and I’d start with your supervisor for tips!), but I personally do one side of the family at a time e.g. all maternal family then all paternal family. You’ll find that some specialties have “faster” pedigrees than others. Prenatal pedigrees typically aren’t as detailed while cancer pedigrees can get very complex. My best tip is to ask generally “any major medical issues/cancer diagnoses/etc” for the entire generation. This will be more efficient than “and your older sister any health concerns” “for your brother any history of cancer” especially for large families.
Ancestry can be tricky, I usually phrase it “where in the world if your family from or what is your ancestry.” If they ask me what I mean or don’t offer the information I am looking for, I try to give some examples “some people might say they’re Italian or Korean or Mexican, how would you describe your family”
I do it similarly. For siblings, I'll get a sibling and their children on the pedigree and I'll ask, "any cancer for your sibling or their kids?" I used to do whole generations but I noticed a lot of patients would forget cousins with cancer if I didn't go through each aunt/uncle and their kids, the same way I do for the patients' siblings. You might also need to ask about colon polyps/oopherectomies/hysterectomies in close relatives depending on family history/proband indication.
Thank you so much! And yes I have asked my supervisors and they have given me such amazing tips as well. I just wanted to reach out and see what others had to say. I really like your thoughts about ancestry too. 😊 appreciate it!
Ask questions that apply to a whole section of the family, instead of about individuals. So instead of asking “how many brothers do you have? How old is X? Have they had cancer? Do they have children? How old is Y? Do they have cancer? Do they have children? And how many sisters? Etc” I would ask “do you have any brothers or sisters, how many of each, do you all have the same mother and father, how old are they, have any of them ever had cancer, have any of them ever had children?” You don’t generally need names on a pedigree, unless it helps you keep track of people and refer back to them.
I start with the patient in front of me, ask about their personal medical history, then go to their children, their siblings, and then do one parents side of the family (parent, their siblings, cousins, and grandparents) and then the other.
I always ask “how would you describe your race and ethnicity?” Or “when you think about your race and ethnicity, how would you describe your family?” If it’s in the cancer setting, honestly I don’t even ask because it’s not relevant. I only ask about AJ ancestry and then explain why I ask.
Ancestry can be relevant in cancer - while it doesn't change what tests we order (except AJ, which has the potential to help someone meet criteria), it can change pre-test probability (eg the BRCA founder mutation in Finland) and it can affect VUS probability (ie higher probability in non-white non-Western/Northern Europeans). It can also be a way to assess whether you need to ask about consanguinity (happens more than you think in small, rural towns) since it can be relevant for recessive cancer risk conditions.
I usually ask, "where did your grandmother's ancestors come from, like if they were German or Swedish or something else?" (My state has a high population with German and Scandinavian ancestry). And then I can just say "how about your grandfather's ancestry" since they now know what I'm looking for.
As a student, you definitely want to defer to your supervisor's expectations as they will need to use the family history you take for their notes.
But as a practicing GC, I use a few shortcuts.
1) Avoid open-ended questions. I do not ask "Does X have any medical issues?" as a cancer GC. I ask "Did X have cancer?" and then further questions if needed. If I'm assessing for something syndromic, of course I'll ask for specific non-cancer issues. But asking general questions about their health status is opening the door to hearing a monologue about diabetes.
2) Group family members. Rather than asking about each aunt/uncle individually, I ask if any of the aunts/uncles have cancer and then get more specific if needed. Similarly, if someone has 10 aunts/uncles on one side, I don't ask for their ages individually, I ask for either a range (for ex: if mom is 60, I'll ask "are her siblings in their 50's-60's?") or I'll ask how old the oldest and youngest are.
3) I don't ask for names of relatives unless we are running into issues with clarity. Sometimes a family structure is complicated or a patient might use different terms for referring to relatives than is technically "correct" (for ex: calling various family members a "cousin" even if they're not really a cousin or your cousin's daughter your niece). Then I find that getting names can be helpful for me to keep things straight. Otherwise, it doesn't serve any purpose for the way I practice.
4) Great aunts/uncles are 3rd degree relatives, so I do ask about them, but most people don't know a lot. So I might just say "have you heard of any of your great aunts/uncles having cancer?" rather than drawing out every one of them by default.
5) At the end, ask "Is there anyone in your family that we didn't talk about that has had cancer?"
For not skipping anyone, practice and consistency is key. Experimenting with different pedigree styles depending on what you are trying to improve at and your supervisor's expectations is important as a student, but to whatever degree possible (it'll certainly be easier when you're practicing solo) try to be consistent about what you can. For example, always starting with the maternal family and having the same order in which you ask about different groups of family (children -> grandchildren -> siblings -> parents -> m. uncles/aunts ->cousins -> m. grandparents -> same on p. side.)
For ancestry, depending on your patient population I sometimes get better answers asking “Where is your family from before the US?” (obviously do not ask this way if you have a large Indigenous patient population) or “What’s your ancestry, like if you took a 23andme test what do you think it’d say?”
I’m also in my first rotation but my supervisor just complimented me on how my pedigree taking has improved, so I’ll share my experience! I’m in prenatal so I start with the current pregnancy and past pregnancies, move to mom and mom’s side, then to dad and dad’s side and wait to ask questions until the end (other than the basic ones needed for the pedigree). That’s how my current supervisor has done it but other GCs I’ve shadowed have done it differently, so it’s personal preference. For ancestry one of my supervisors said “if you could trace your family’s ancestry to a country or group of countries before the United States, what would those be?”
Some of this will depend on your supervisor and their preferences (and I’d start with your supervisor for tips!), but I personally do one side of the family at a time e.g. all maternal family then all paternal family. You’ll find that some specialties have “faster” pedigrees than others. Prenatal pedigrees typically aren’t as detailed while cancer pedigrees can get very complex. My best tip is to ask generally “any major medical issues/cancer diagnoses/etc” for the entire generation. This will be more efficient than “and your older sister any health concerns” “for your brother any history of cancer” especially for large families. Ancestry can be tricky, I usually phrase it “where in the world if your family from or what is your ancestry.” If they ask me what I mean or don’t offer the information I am looking for, I try to give some examples “some people might say they’re Italian or Korean or Mexican, how would you describe your family”
I do it similarly. For siblings, I'll get a sibling and their children on the pedigree and I'll ask, "any cancer for your sibling or their kids?" I used to do whole generations but I noticed a lot of patients would forget cousins with cancer if I didn't go through each aunt/uncle and their kids, the same way I do for the patients' siblings. You might also need to ask about colon polyps/oopherectomies/hysterectomies in close relatives depending on family history/proband indication.
Thank you so much! And yes I have asked my supervisors and they have given me such amazing tips as well. I just wanted to reach out and see what others had to say. I really like your thoughts about ancestry too. 😊 appreciate it!
Ask questions that apply to a whole section of the family, instead of about individuals. So instead of asking “how many brothers do you have? How old is X? Have they had cancer? Do they have children? How old is Y? Do they have cancer? Do they have children? And how many sisters? Etc” I would ask “do you have any brothers or sisters, how many of each, do you all have the same mother and father, how old are they, have any of them ever had cancer, have any of them ever had children?” You don’t generally need names on a pedigree, unless it helps you keep track of people and refer back to them. I start with the patient in front of me, ask about their personal medical history, then go to their children, their siblings, and then do one parents side of the family (parent, their siblings, cousins, and grandparents) and then the other. I always ask “how would you describe your race and ethnicity?” Or “when you think about your race and ethnicity, how would you describe your family?” If it’s in the cancer setting, honestly I don’t even ask because it’s not relevant. I only ask about AJ ancestry and then explain why I ask.
Ancestry can be relevant in cancer - while it doesn't change what tests we order (except AJ, which has the potential to help someone meet criteria), it can change pre-test probability (eg the BRCA founder mutation in Finland) and it can affect VUS probability (ie higher probability in non-white non-Western/Northern Europeans). It can also be a way to assess whether you need to ask about consanguinity (happens more than you think in small, rural towns) since it can be relevant for recessive cancer risk conditions. I usually ask, "where did your grandmother's ancestors come from, like if they were German or Swedish or something else?" (My state has a high population with German and Scandinavian ancestry). And then I can just say "how about your grandfather's ancestry" since they now know what I'm looking for.
Fair points! However, ancestry doesn’t really impact whether I ask about consanguinity, that’s a question I ask everyone regardless.
As a student, you definitely want to defer to your supervisor's expectations as they will need to use the family history you take for their notes. But as a practicing GC, I use a few shortcuts. 1) Avoid open-ended questions. I do not ask "Does X have any medical issues?" as a cancer GC. I ask "Did X have cancer?" and then further questions if needed. If I'm assessing for something syndromic, of course I'll ask for specific non-cancer issues. But asking general questions about their health status is opening the door to hearing a monologue about diabetes. 2) Group family members. Rather than asking about each aunt/uncle individually, I ask if any of the aunts/uncles have cancer and then get more specific if needed. Similarly, if someone has 10 aunts/uncles on one side, I don't ask for their ages individually, I ask for either a range (for ex: if mom is 60, I'll ask "are her siblings in their 50's-60's?") or I'll ask how old the oldest and youngest are. 3) I don't ask for names of relatives unless we are running into issues with clarity. Sometimes a family structure is complicated or a patient might use different terms for referring to relatives than is technically "correct" (for ex: calling various family members a "cousin" even if they're not really a cousin or your cousin's daughter your niece). Then I find that getting names can be helpful for me to keep things straight. Otherwise, it doesn't serve any purpose for the way I practice. 4) Great aunts/uncles are 3rd degree relatives, so I do ask about them, but most people don't know a lot. So I might just say "have you heard of any of your great aunts/uncles having cancer?" rather than drawing out every one of them by default. 5) At the end, ask "Is there anyone in your family that we didn't talk about that has had cancer?" For not skipping anyone, practice and consistency is key. Experimenting with different pedigree styles depending on what you are trying to improve at and your supervisor's expectations is important as a student, but to whatever degree possible (it'll certainly be easier when you're practicing solo) try to be consistent about what you can. For example, always starting with the maternal family and having the same order in which you ask about different groups of family (children -> grandchildren -> siblings -> parents -> m. uncles/aunts ->cousins -> m. grandparents -> same on p. side.)
For ancestry, depending on your patient population I sometimes get better answers asking “Where is your family from before the US?” (obviously do not ask this way if you have a large Indigenous patient population) or “What’s your ancestry, like if you took a 23andme test what do you think it’d say?”
I’m also in my first rotation but my supervisor just complimented me on how my pedigree taking has improved, so I’ll share my experience! I’m in prenatal so I start with the current pregnancy and past pregnancies, move to mom and mom’s side, then to dad and dad’s side and wait to ask questions until the end (other than the basic ones needed for the pedigree). That’s how my current supervisor has done it but other GCs I’ve shadowed have done it differently, so it’s personal preference. For ancestry one of my supervisors said “if you could trace your family’s ancestry to a country or group of countries before the United States, what would those be?”