Rogers J C, Cohn P
Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854-5635.
Fam Pract. 1987 Dec;4(4):291-301. doi: 10.1093/fampra/4.4.291.
The family genogram is generally used when the clinical situation suggests that a family assessment is warranted. Owing to the prevalence of psychosocial problems in primary care, a screening genogram that is administered to patients routinely may have a significant impact on the care provided by clinicians. A randomized controlled trial was conducted to determine the influence of screening genograms on patients' initial visits to primary care physicians. The genograms captured more information about family structure, major life events, repetitive illnesses, and family relationships than did the physicians on their own. Nevertheless, the experimental and control groups were no different on the dependent variables: physician exploration of family issues, request for interviews with other family members and counseling or referral because of emotional problems. Although the power of the study alone could account for the lack of significant results, several other methodological issues, especially contamination of the control group, could have contributed to the negative results. The results of this study are similar to those of other psychosocial screening studies using similar designs. Hence, additional studies using alternative research protocols are indicated before rejecting the usefulness of screening genograms in primary care.
当临床情况表明有必要进行家庭评估时，通常会使用家族谱。由于初级保健中社会心理问题普遍存在，对患者常规进行的筛查家族谱可能会对临床医生提供的护理产生重大影响。开展了一项随机对照试验，以确定筛查家族谱对患者初次就诊于初级保健医生的影响。与医生自行了解的情况相比，家族谱获取了更多关于家庭结构、重大生活事件、反复出现的疾病以及家庭关系的信息。然而，在因情绪问题而进行的以下因变量方面，实验组和对照组并无差异：医生对家庭问题的探究、要求与其他家庭成员面谈以及咨询或转诊。尽管仅研究的效力可能是缺乏显著结果的原因，但其他几个方法学问题，尤其是对照组受到的干扰，可能导致了负面结果。本研究的结果与其他采用类似设计的社会心理筛查研究的结果相似。因此，在否定筛查家族谱在初级保健中的有用性之前，需要使用替代研究方案进行更多研究。
