Impact of Remote Familial Risk Assessment and Counseling

项目总结摘要 高危家庭成员坚持定期结肠镜筛查的比率 结直肠癌(CRC)远远低于推荐水平。居住在美国农村地区的人 表现出比城市同龄人更低的结直肠癌筛查率。虽然检测到的是家族性 癌症的易感性始于准确的家族病史，数据表明许多患者并不是这样。 从初级保健提供者那里获得充分的家族性癌症风险评估。这表明，家族性 风险在很大程度上没有被认识到，这可能导致风险分层不充分，缺乏风险通知，适当 风险咨询、次优癌症筛查和可预防的死亡。因为地理和系统的原因- 水平障碍，需要特别努力来改善个性化风险沟通和遵守的机会 在罹患结直肠癌风险较高的农村居民中进行结直肠癌筛查。在拟议的研究中，我们将评估一部小说 结合家族性CRC的基于电话的、理论指导的个性化风险沟通干预 通过量身定制的信息进行风险评估和行为咨询。指导这项研究的关键假设是 更密集的个性化风险沟通干预将显著提高CS 比低强度的有针对性的打印干预速度更快。我们的综合研究模式指定了重要的理论 有助于在风险增加的人群中增加使用CS的机制。我们将招收712人 40岁及以上的农村成年男性和女性，被认为是家族性结直肠癌风险增加的人 这是一项2组随机试验。这项研究的主要目的是比较参与者中结肠镜检查的使用情况 在两组中。次要目标是比较两组人在认知和情感方面的差异 并探讨干预措施对以下方面产生影响的潜在机制 结肠镜检查行为。将收集社会人口学、临床、行为和心理社会测量 从参与者在基线、1个月、6个月和1年时开始。这项研究的发现既有理论上的，也有 以及现实的、有意义的。我们的发现将有助于影响有效的选择和传播 在患病风险较高的人群中改进结直肠癌筛查的外展方法。这些结果 具有广泛的适用性，可用于了解对其他个人风险沟通干预措施的反应 疾病也是如此。这些发现也将拓宽我们对心力衰竭潜在理论机制的理解。 远程癌症风险沟通如何在地理位置不同的人群中改善癌症筛查 如果观察到这种干预效果，服务不足的人群

PROJECT SUMMARY ABSTRACT The rate of adherence to regular colonoscopy screening among members of families at increased risk for colorectal cancer (CRC) is far below recommended levels. Persons who live in rural areas of the United States exhibit lower colorectal screening rates than their urban counterparts. Although the detection of familial predisposition to cancer begins with an accurate family medical history, data indicate that many patients do not receive adequate familial cancer risk assessment from their primary care providers. This suggests that familial risk is largely unrecognized which may lead to inadequate risk stratification, lack of risk notification, appropriate risk counseling, suboptimal cancer screening and preventable deaths. Because of geographic and system- level barriers, special efforts are needed to improve access to personalized risk communication and adherence to CRC screening in rural dwellers at increased risk for CRC. In the proposed study, we will evaluate a novel telephone-based, theory-guided personalized risk communication intervention that combines a familial CRC risk assessment and behavioral counseling with tailored messages. The key hypothesis guiding this study is that a more intensive personalized risk communication intervention will improve CS at a significantly higher rate than a low-intensity targeted print intervention. Our integrative study model specifies important theoretical mechanisms that can contribute to increased use of CS among persons at increased risk. We will enroll 712 rural adult men and women age 40 years and older who are considered at increased risk of familial CRC into this 2-group randomized trial. The primary aim of this study is to compare colonoscopy use among participants in the two groups. Secondary aims are to compare the two groups with regard to cognitive and emotional outcomes and explore the underlying mechanisms through which the interventions have an impact on colonoscopy behavior. Sociodemographic, clinical, behavioral and psychosocial measures will be collected from participants at baseline, 1 month, 6 months and 1 year. The study's findings will have both theoretical, as well as practical, significance. Our findings will help to influence the selection and dissemination of effective outreach approaches to improve CRC screening in populations at increased risk for the disease. These results have broad applicability to understanding responses to personalized risk communication interventions for other diseases as well. Findings will also broaden our understanding of the underlying theoretical mechanisms of how remote cancer risk communications lead to improvements in cancer screening among geographically underserved populations if such intervention effects are observed