Wexler Jade H, Toll Elizabeth, Goldman Roberta E
The Warren Alpert Medical School of Brown University, Providence, Rhode Island
The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Ann Fam Med. 2025 Jan 27;23(1):24-34. doi: 10.1370/afm.240146.
Adoption has lifelong health implications for 7.8 million adopted people and their families in the United States. The majority of adoptees have limited family medical history (LFMH). Primary care physicians (PCPs) rarely receive training about adoptees including their mental health needs and increased suicide risk. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for PCPs to be prepared to address genetic testing for adoptees with LFMH. This study explores PCP training and approaches to adult adopted patients with LFMH.
We used critical adoption studies as a theoretical framework for this study to understand how adoptive identity might shape clinical experiences. We recruited PCPs from Minnesota and Rhode Island via purposive, criteria-based, reputational sampling. We conducted hour-long semistructured qualitative interviews incorporating hypothetical clinical vignettes. Transcripts were coded via template organizing method and analyzed via Immersion-Crystallization.
We interviewed 23 PCPs. They reported receiving little training or resources on adult adoptees with LFMH and showed substantial knowledge gaps regarding mental health and genetic testing for this population. Many failed to adjust history-taking and primary care approaches, which they recognized as potentially resulting in inaccuracies, inappropriate clinical care, and microaggressions while inadvertently triggering anxiety, shame, and distrust among patients. A mismatch between adopted patients' and physicians' understandings of family medical history could strain the therapeutic relationship. Nearly all interviewees viewed additional training to care for adult adoptees with LFMH as beneficial.
Future research should expand education and training for PCPs on adult adoptees with LFMH.
收养对美国780万被收养者及其家庭有着终身的健康影响。大多数被收养者的家族病史有限（LFMH）。初级保健医生（PCP）很少接受关于被收养者的培训，包括他们的心理健康需求和增加的自杀风险。直接面向消费者的基因检测试剂盒越来越容易获得且越来越受欢迎，这凸显了初级保健医生准备好应对LFMH被收养者基因检测的必要性。本研究探讨初级保健医生对LFMH成年被收养患者的培训及方法。
我们将关键收养研究作为本研究的理论框架，以了解收养身份如何塑造临床体验。我们通过有目的、基于标准、声誉抽样的方式从明尼苏达州和罗德岛招募初级保健医生。我们进行了长达一小时的半结构化定性访谈，并纳入了假设的临床案例。通过模板组织法对访谈记录进行编码，并通过沉浸 - 结晶法进行分析。
我们采访了23名初级保健医生。他们表示在LFMH成年被收养者方面接受的培训或资源很少，并且在该人群的心理健康和基因检测方面存在重大知识差距。许多人未能调整病史采集和初级保健方法，他们意识到这可能导致不准确、不适当的临床护理以及微侵犯行为，同时无意中引发患者的焦虑、羞耻和不信任。被收养患者和医生对家族病史的理解不匹配可能会使治疗关系紧张。几乎所有受访者都认为对LFMH成年被收养者的额外培训是有益的。
未来的研究应扩大对初级保健医生关于LFMH成年被收养者的教育和培训。
