Impact of Remote Familial Risk Assessment and Counseling

项目摘要 在有高风险的家庭成员中，坚持定期结肠镜筛查的比例 结直肠癌（CRC）的发病率远低于推荐水平。居住在美国农村地区的人 结肠直肠癌筛查率低于城市居民。虽然检测到家族性 癌症的易感性始于准确的家族病史，数据表明许多患者不 从他们的初级保健提供者那里获得足够的家庭癌症风险评估。这表明， 风险在很大程度上未被认识到，这可能导致风险分层不充分，缺乏风险通知， 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- 水平的障碍，需要特别努力，以改善获得个性化的风险沟通和遵守 在农村居民中进行CRC筛查的风险增加。在拟议的研究中，我们将评估一部小说， 基于电话的、理论指导的个性化风险沟通干预， 风险评估和行为咨询，并提供量身定制的信息。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以显著更高的 比低强度有针对性的印刷干预率。我们的综合研究模式规定了重要的理论 可能有助于增加风险增加的人使用CS的机制。我们将招收712名学生 年龄在40岁及以上的农村成年男性和女性，被认为具有增加的家族性CRC风险， 这个两组随机试验本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。第二个目的是比较两组在认知和情感方面的差异。 成果，并探讨干预措施对 结肠镜检查行为。将收集社会人口统计学、临床、行为和心理社会指标 在基线、1个月、6个月和1年时的参与者。这项研究的结果将具有理论性， 以及实际意义。我们的研究结果将有助于影响选择和传播有效的 推广方法，以改善疾病风险增加的人群中的CRC筛查。这些结果 具有广泛的适用性，以了解对个性化风险沟通干预措施的反应， 疾病也是。研究结果也将拓宽我们对潜在的理论机制的理解， 远程癌症风险沟通如何改善地理上的癌症筛查 如果观察到这种干预措施的效果，

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