Enabling family communication about cancer - Do you know your Kin Facts?

描述（由申请人提供）：尽管医学和技术进步，癌症健康差距继续发生在预防，诊断和结果。家族健康史（FH）是已知最强的癌症（CA）预测因子之一，也是遗传性CA风险最强大、最公开的筛查方法。为了填补差距，在必要的家庭沟通的实际干预措施，我们建议开发和评估临床综合干预措施，以改善患者与家庭的沟通有关CA的风险和预防。使用Kin Fact Program（保持有关家庭癌症调整计划的信息），研究助理（RA）将与245名成年女性进行1对1的工作，这些女性在VCU女性健康诊所的年度妇科就诊中招募了两年。RA将帮助参与者绘制家谱，识别生物亲属，并记录患有乳腺癌（BC）或结肠癌（CC）的生物家族的信息。在这20-30分钟的会议中，助理将：（a）提供风险信息和适当的健康建议;（B）确定完成家庭健康调查所需的家庭信息;（c）指导妇女掌握获取信息的沟通技巧;（d）与她一起制定收集和跟踪这一数据收集的计划。另外245名随机分配到对照组的妇女将接受标准治疗。我们将测试干预组和对照组之间在有关CA的家庭沟通的主要结果方面的差异。我们还将在干预后1个月、6个月和14个月，使用书面基线调查和结构化随访电话访谈，评估干预对CA相关遗传知识和风险降低行为的影响。大约45%的VCU妇女健康诊所的病人是非洲裔美国人，大约三分之一的人保险不足。通过将该模型整合到城市妇女健康安全网诊所中，该项目解决了种族多样性、包容性做法和临床翻译等癌症控制和预防研究挑战。我们的长期目标是：改善公共卫生，特别是与BC和CC有关，通过FH收集和交流最大限度地提高遗传风险评估，消除从家族风险信息中受益的差异，并确定使妇女成为有效FH和癌症预防传播者的成功方法。具体目标：1.评估Kin Fact计划对BC和CC FH沟通的影响。我们将研究种族/民族和教育作为影响因素。2.评估变化差异（干预与控制），在报告的家庭沟通环境和他们的中介作用的沟通成果。3.评估有关CA相关遗传信息的关键知识的变化差异（干预与对照）（一般而言，癌症遗传成分的知识以及其特定的个体风险和识别资源的能力）。4.作为次要目标，我们将检查健康行为差异（干预与对照）（例如，临床乳房检查，乳房X光检查，结肠镜检查，USPSTF实践等）对于这些筛选行为适用的参与者子集。 公共卫生相关性：21世纪世纪预防和控制癌症的公共卫生方法需要纳入遗传信息，家族健康史是最容易获得的。与白人相比，非洲裔美国人所有癌症的死亡率更高，这需要努力探索家庭对癌症风险理解的差异。至关重要的是，要了解如何通过在妇女初级保健中采取可获得的干预措施，改善家庭成员之间关于癌症风险和预防的沟通，并确保这些干预措施公平有效。

DESCRIPTION (provided by applicant): Despite medical and technological advances, cancer health disparities continue to occur in prevention, diagnosis, and outcomes. Family health history (FH) is among the strongest known predictors of cancer (CA) and is the most powerful, publicly accessible screen for genetic CA risk. To fill the gap in practical interventions for necessary family communication, we propose to develop and evaluate a clinically integrated intervention to improve patient-family communication about CA risk and prevention. Using the Kin Fact Program (Keeping Information about Family Cancer Tune-up Program), a research assistant (RA) will work 1-on-1 with 245 adult women, recruited over the course of 2 years from annual gynecology visits at the VCU Women's Health Clinic within a randomized trial. The RA will help participants draw a family tree, identify biological kin, and document information about biological family who have had breast cancer (BC) or colon cancer (CC). In this 20-30 minute session, the assistant will: (a) provide risk information and appropriate health recommendations; (b) identify family information needed to complete the FH; (c) coach woman in communication skills to obtain information, and (d) develop, with her, a plan for collection and follow-up on this data gathering. Another 245 women randomized to the control arm will receive standard care. We will test for differences between the intervention and control groups on the primary outcome of family communication about CA. We will also assess the intervention impact on CA-related genetic knowledge and risk-reduction behaviors at 1, 6, and 14 months after the intervention, using written baseline surveys and structured follow-up phone interviews. About 45% of the VCU Women's Health Clinic patients are African-American and about 1/3 are under-insured. By integrating the model within an urban women's health safety-net clinic, this project addresses cancer control and prevention research challenges of racial diversity, inclusive practices, and clinical translation. Our long-term objectives are to: improve public health, specifically related to BC and CC, by maximizing genetic risk assessment through FH collection and communication, eliminate disparities in who benefits from familial risk information, and identify successful methods for enabling women to be effective FH and cancer prevention communicators. Specific aims: 1. Assess the effect of the Kin Fact program on communication about FH of BCs and CCs. We will investigate race/ethnicity and education as effect modifiers. 2. Assess change differences (intervention vs. control) in reported family communication contexts and their mediator effects on communication outcomes. 3. Assess change differences (intervention vs. control) in critical knowledge about CA-related genetic information (knowledge of the genetic component to cancer, in general and also their specific individual risks and capacity to identify resources). 4. As a secondary aim we will examine health behavior differences (intervention vs. control) (e.g. clinical breast exams, mammograms, colonoscopy, USPSTF practices, etc.) for the subset of participants to whom these screening behaviors apply. PUBLIC HEALTH RELEVANCE: Twenty-first century public health approaches to cancer prevention and control need to incorporate genetic information, family health history being the most accessible. The higher death rates from all cancers in African Americans compared to Caucasians demand efforts to explore disparities in family understanding of cancer risk. It is critical to understand ways to improve communication about cancer risk and prevention among family members through accessible interventions in women's primary care, and to ensure the interventions are equitably effective.