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

描述(由申请人提供)：尽管医学和技术取得了进步，但癌症在预防、诊断和结果方面的健康差距仍在继续。家族健康史(FH)是已知的癌症(CA)最强的预测因子之一，也是最有效的、可公开访问的遗传CA风险筛查。为了填补在必要的家庭沟通的实际干预方面的空白，我们建议开发和评估临床综合干预措施，以改善关于CA风险和预防的患者与家庭之间的沟通。使用Kin Fact计划(保留关于家庭癌症调整计划的信息)，一名研究助理(RA)将与245名成年女性进行一对一的工作，这些女性是在随机试验中从VCU妇女健康诊所的年度妇科就诊中招募的，历时两年。RA将帮助参与者绘制家谱，识别亲缘关系，并记录有关患有乳腺癌(BC)或结肠癌(CC)的亲生家庭的信息。在这个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FH所需的家庭信息；(C)指导妇女掌握获得信息的沟通技能；以及(D)与她一起制定收集和跟踪这一数据收集的计划。另外245名被随机分配到对照组的女性将接受标准护理。我们将检验干预组和对照组在CA家庭沟通的主要结果上的差异。我们还将在干预后1、6和14个月通过书面基线调查和结构化电话访谈评估干预对CA相关遗传知识和降低风险行为的影响。VCU妇女健康诊所约45%的患者是非裔美国人，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方面的癌症控制和预防研究挑战。我们的长期目标是：通过FH收集和传播最大限度地进行遗传风险评估，改善公共健康，特别是与BC和CC相关的公共健康，消除谁受益于家族风险信息的差异，并确定使妇女成为有效的FH和癌症预防传播者的成功方法。具体目标：1.评估Kin FACT项目对BCS和CCS跳频沟通的影响。我们将调查种族/民族和教育作为影响因素。2.评估在已报告的家庭沟通环境中的变化差异(干预与对照)及其对沟通结果的中介效应。3.评估关于CA相关遗传信息的关键知识的变化差异(干预和控制)(一般关于癌症的遗传成分的知识及其具体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做法等)。适用于这些筛选行为的参与者子集。 公共卫生相关性：21世纪预防和控制癌症的公共卫生方法需要纳入遗传信息，家庭健康史是最容易获得的。与高加索人相比，非裔美国人死于所有癌症的死亡率更高，这要求努力探索家庭对癌症风险理解的差异。关键是要了解如何通过妇女初级保健中可获得的干预措施来改善家庭成员之间关于癌症风险和预防的沟通，并确保干预措施同样有效。

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.