Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial
Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial
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DOI：
10.1111/codi.12880
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发表时间：
2015-06-01
影响因子：
3.4
通讯作者：
Hoogerbrugge, N.
中科院分区：
文献类型：
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作者：
Dekker, N.;Hermens, R. P.;Hoogerbrugge, N.
只有12-49%的结直肠癌（CRC）患者及其家族性CRC风险增加的一级亲属被推荐接受癌症预防措施（监测结肠镜检查或遗传咨询）。进行这项研究，以评估一种新的策略，以提高高风险的个人和监测结肠镜检查为中度risks.MethodEighteen医院参加了一个集群的随机对照试验的遗传咨询的有效性和可行性。9家医院的患者接受常规护理（A组）。其他九家医院接受了新的策略（B组），包括访问患者和临床医生的网站，针对患者的小册子和针对临床医生的教育和袖珍转诊卡。结果在该策略传播之前，820名CRC患者中有358名（44%）和137名临床医生中有50名（36%）的数据完整，在该策略传播之前，有392/862名患者（45%）和47/137名临床医生（34%）的数据完整。在策略传播前，A组和B组在CRC诊断后中位数为8（2-12）个月时评估癌症预防措施的转诊情况，在策略传播后，A组在CRC诊断后中位数为8（2-12）个月时评估。在B组中，在策略传播后中位9（4-11）个月评估转诊情况。A组和B组高危患者接受遗传咨询的比例相同，治疗前为33%，治疗后为15%（P=0.003）。中度风险亲属对监测结肠镜检查的接受率没有显著变化（A组，术前36% vs术后41%; B组，术前33% vs术后19%）。在B组中，94/140例患者（67%）和25/72名临床医生（35%）访问了网站，34/140例患者（24%）阅读了手册。患者认为临床医生的信息最有用，其次是患者手册。临床医生更喜欢口袋卡和education.ConclusionOur策略没有提高癌症预防措施的转诊。虽然新提供的策略元素受到赞赏，但患者更喜欢临床医生关于癌症预防措施的建议。它可能是有用的，以医疗保健专业人员，而不是病人，以改善预防家族性癌症的未来干预措施。
AimOnly 12-49% of colorectal cancer (CRC) patients and their first-degree relatives with an increased familial CRC risk are referred for cancer prevention measures (surveillance colonoscopies or genetic counselling). The study was performed to evaluate the effectiveness and feasibility of a novel strategy to improve the uptake of genetic counselling for high risk individuals and surveillance colonoscopy for moderate risk groups.MethodEighteen hospitals participated in a clustered randomized controlled trial. Patients in nine hospitals received usual care (group A). Nine other hospitals received the novel strategy (group B) including access to a website for patients and clinicians, patient-targeted brochures and clinician-targeted education and pocket referral cards. Data before and after dissemination of the strategy were collected from questionnaires and medical records.ResultsData were complete for 358 (44%) of 820 CRC patients and 50 (36%) of 137 clinicians before dissemination of the strategy and 392/862 patients (45%) and 47/137 clinicians (34%) after. Referral for cancer prevention measures was assessed at a median of 8 (2-12) months after CRC diagnosis in groups A and B before the dissemination of the strategy and in group A after. In group B referral was assessed at a median of 9 (4-11) months after the dissemination of the strategy. Uptake of genetic counselling by high risk patients was equal in groups A and B, being 33% before and 15% after (P=0.003). Uptake of surveillance colonoscopy by moderate risk relatives did not change significantly (group A, 36% before vs 41% after; group B, 33% before vs 19% after). In group B 94/140 patients (67%) and 25/72 clinicians (35%) visited the website and 34/140 (24%) patients read the brochure. Patients valued clinicians' information as most useful, followed by the patient brochure. Clinicians preferred pocket cards and education.ConclusionOur strategy did not improve referral for cancer prevention measures. Although the newly offered strategy elements were appreciated, patients preferred clinicians' advice regarding referral for cancer prevention measures. It may be useful to aim future interventions at healthcare professionals rather than patients to improve the prevention of familial cancer.