Impact of Remote Familial Risk Assesment and Counseling

描述(由申请人提供)：结直肠癌高危家庭成员坚持定期结肠镜检查的比率远低于推荐水平。居住在美国农村地区的人表现出比城市人更低的结直肠癌筛查率。虽然家族性癌症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得到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，这可能会导致风险分层不充分、缺乏风险通知、缺乏适当的风险咨询、次佳的癌症筛查和可预防的死亡。由于地理和系统层面的障碍，需要特别努力改善获得个性化风险沟通的机会，并在儿童权利委员会风险增加的农村居民中遵守儿童权利公约筛查。在拟议的研究中，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，它结合了家族性CRC风险评估和行为咨询与定制的信息。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显著高于低强度的定向印刷干预，从而显著提高CS的改善速度。我们的综合研究模型指定了重要的理论机制，这些机制有助于在风险增加的人群中增加CS的使用。我们将712名年龄在40岁及以上的农村成年男性和女性纳入这项两组随机试验，他们被认为是家族性结直肠癌风险增加的人。这项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。次要目标是比较两组在认知和情感方面的结果，并探索干预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年收集参与者的社会人口学、临床、行为和心理社会测量。这项研究的发现将具有理论和实践两方面的意义。我们的发现将有助于影响选择和传播有效的外展方法，以改善在疾病风险增加的人群中进行结直肠癌筛查。这些结果对于理解针对其他疾病的个性化风险沟通干预措施的反应也具有广泛的适用性。这些发现还将扩大我们对潜在的理论机制的理解，即如果观察到这种干预效果，远程癌症风险沟通如何导致在地理上服务不足的人群中改善癌症筛查。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平等地获得癌症通信。这种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，提高患结直肠癌(CRC)风险增加的农村居民的筛查率。我们的研究高度响应国家健康传播和健康差距优先事项，并将提供必要的数据，以影响向居住在地理服务不足地区的高危个人制定和传播有效的癌症传播干预措施。

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.