Promoting Colon Cancer Screening in At Risk Families

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DESCRIPTION (provided by applicant): Colorectal cancer is the second leading cause of cancer-related death in U.S. Screening rates among individuals at increased risk of the disease because of a family history colorectal cancer or adenomas are suboptimal. Preliminary studies highlight the need for novel strategies to increase both provider and patient awareness of familial risk factors, promote compliance with appropriate screening recommendations, and facilitate risk communication between providers, affected patients and at-risk family members. Accordingly, the specific aims described herein address each of these needs by proposing novel interventions targeted at providers, adenoma patients and at-risk relatives. Specific Aim #1 is to design, implement and evaluate an educational program for primary care housestaff and assess its impact on their knowledge, risk assessment and screening behavior. The educational program will incorporate both didactic and interactive teaching sessions as well as distribution of a colorectal cancer risk assessment "tool kit." The actual content of the sessions and "tool kit" will be defined during Year 1 using existing literature, focus groups and an expert panel. A randomized controlled trial will be conducted in Year 2 to evaluate the program's effectiveness. A pretest/post-test format will be used to assess knowledge, patient exit interviews will be used to assess risk assessment skills, and chart audit with feedback will be used to assess documentation and screening behavior. Specific Aim #2 is to evaluate the efficacy of an educational program aimed at promoting increased awareness about familial risk and notification of first-degree relatives among adenoma patients. The program employs a standardized computer-based educational intervention that is conducted at the "bedside" immediately post-polypectomy, followed by a tailored notification of risk and recommendations in the form of a personalized letter. A three-arm randomized trial comparing the dual intervention to the bedside computer-based intervention alone versus standard care will be conducted to assess the program's effectiveness. Telephone surveys will be used to assess patient knowledge and extent of communication to at-risk siblings. Specific Aim #3 is to explore patient preferences and the role of shared decision-making as a strategy for promoting compliance with colorectal cancer screening recommendations among individuals with a family history of colorectal adenomas or cancer. Structured interviews will be conducted to assess patient preferences for the five recommended screening strategies colorectal cancer screening strategies, identify factors influencing their choices, and determine the extent to which such patients wish to participate in tho decision-making process using a validated "decision aid" and "Colorectal Cancer Autonomy Index/Autonomy Preference Index."