Impact of Remote Familial Risk Assesment and Counseling

描述（由申请人提供）：在结直肠癌（CRC）风险增加的家庭成员中，坚持定期结肠镜筛查的比例远低于推荐水平。生活在美国农村地区的人表现出较低的结直肠癌筛查率比城市同行。虽然癌症家族易感性的检测始于准确的家族病史，但数据表明，许多患者没有从他们的初级保健提供者那里获得足够的家族性癌症风险评估。这表明家族性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，适当的风险咨询，次优的癌症筛查和可预防的死亡。由于地理和系统层面的障碍，需要特别努力，以改善获得个性化的风险沟通，并坚持在农村居民的CRC筛查风险增加。在这项拟议的研究中，我们将评估一种新的基于电话的，理论指导的个性化风险沟通干预，该干预将家族性CRC风险评估和行为咨询与定制信息相结合。指导本研究的关键假设是，更密集的个性化风险沟通干预将以比低强度有针对性的打印干预更高的速度改善CS。我们的综合研究模型指定了重要的理论机制，可以有助于增加使用CS的人在风险增加。我们将招募712名40岁及以上的农村成年男性和女性，他们被认为是家族性CRC风险增加的患者进入这项2组随机试验。本研究的主要目的是比较两组参与者的结肠镜检查使用情况。次要目的是比较两组在认知和情绪方面的结果，并探讨干预措施对结肠镜检查行为产生影响的潜在机制。将在基线、1个月、6个月和1年时收集参与者的社会人口统计学、临床、行为和心理社会指标。这项研究的结果将具有理论意义和实际意义。我们的研究结果将有助于影响有效外展方法的选择和传播，以改善疾病风险增加的人群中的CRC筛查。这些结果也具有广泛的适用性，可以理解对其他疾病的个性化风险沟通干预措施的反应。研究结果还将拓宽我们对远程癌症风险沟通如何改善地理上服务不足的人群癌症筛查的潜在理论机制的理解，如果观察到这种干预效果。公共卫生相关性：通过电话提供个性化的风险评估和行为咨询服务可能会确保农村和其他服务不足的群体公平地获得癌症通信。这些干预措施有可能通过消除获得可能挽救生命的癌症风险信息的地理和其他障碍，提高农村居民中患结肠直肠癌风险增加的筛查率。我们的研究高度响应国家健康传播和健康差异的优先事项，并将提供影响有效癌症传播干预措施的发展和传播所需的数据，这些干预措施针对居住在地理服务不足地区的高危人群。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Provision of personalized risk assessment and behavioral counseling services via the telephone is likely to ensure equitable access to cancer communications for rural and other underserved groups. Such interventions have the potential to translate into improved colorectal cancer (CRC) screening rates among rural dwellers at increased risk for the disease by removing geographic and other barriers to accessing potentially life-saving cancer risk communications. Our study is highly responsive to national health communication and health disparity priorities, and will provide data that are needed to influence the development and dissemination of effective cancer communication interventions to high-risk individuals who reside in geographically underserved areas.