A Randomized Trial of Generic Versus Tailored Interventions to Increase Colorectal Cancer Screening Among Intermediate Risk Siblings

Abstract

Individuals with a sibling who has had colorectal cancer diagnosed before age 61 are at increased risk for colorectal cancer and may derive particular benefit from screening. Tailored interventions may increase participation in appropriate colorectal cancer screening. This study evaluated the efficacy of two tailored interventions and a generic print intervention. Participant siblings (N = 412) who were not up-to-date with colorectal cancer screening were randomly assigned to receive either a generic print pamphlet, a tailored print pamphlet, or a tailored print pamphlet and tailored counseling call. Colorectal cancer screening six months after the baseline interview was the outcome measure. Results indicated that colorectal cancer screening adherence increased among intermediate risk siblings enrolled in all three intervention groups. Participants in both tailored intervention groups reported having colorectal cancer screening at significantly higher rates than participants in the generic print group. The increase in colorectal cancer screening in the tailored print and counseling call group was not significantly higher than that achieved by the tailored print alone. Decisional balance partially mediated treatment effects. Tailored behavioral interventions are an effective NIH Public Access Author ManuscriptAnn Behav Med. Author manuscript; available in PMC 2010 April 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript method for increasing screening adherence but telephone counseling did not add significantly to treatment effects. KeywordsColorectal cancer screening; tailored interventions; intermediate risk siblingsColorectal cancer (CRC) is the fourth most commonly diagnosed cancer and the second leading cause of cancer deaths in the United States (1). Lifetime risk for CRC is approximately 5% after age 50. Individuals with a first-degree relative (FDR; sibling, parent, child) diagnosed with CRC have an estimated lifetime CRC risk of 10% (2-4). The risk increases as the age of the proband at diagnosis decreases (5,6) with estimates ranging between two and four times the average risk (3,5).Screening results in earlier detection of CRC and reduces disease-specific mortality (7,8).Various agencies have published screening guidelines for relatives of CRC patients. A number of professional organizations recommend that FDRs should follow population screening guidelines but begin CRC screening (CRCS) at a younger age than general guidelines with recommended screening starting at age 40 (9). Others specifically recommend colonoscopy starting at an age that depends on the family history (1). Estimates of CRCS among family members at increased risk for CRC have varied widely with reported rates of 22% (10), 39% (11), 55% (12), 64% (13) and 79% (14), depending upon the screening procedure examined and the targeted at-risk population.Given the increased risk for CRC among FDRs of individuals diagnosed with CRC and the relatively low participation in this at-risk population, effective me...

Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial

“…Consistent with other studies, our results indicate that prior CRCS experience predicts screening completion among those who were overdue at Year 1, as well as repeat, on-schedule screening at Year 2 (Vernon et al, 2011; Sifri et al, 2010; Manne et al, 2009; Myers et al, 2007). In the moderation analysis, prior CRCS had a stronger association with screening in the combined intervention groups compared with usual care, suggesting the intervention amplified the effect of prior screening experience.…”

Sociopsychological Tailoring to Address Colorectal Cancer Screening Disparities: A Randomized Controlled Trial

“…Of previous randomized controlled trials comparing a sociopsychologically tailored colorectal cancer screening intervention with an active control, 15,19,20,22,[25][26][27][28][29][30]33 only some reported improvements in screening, 19,25,28,29,34 in most instances based on patient report, 19,25,28,29 suggesting possible misclassification bias. These observations, plus our current findings, raise doubts about the superiority of sociopsychological tailoring to nontailored approaches in promoting colorectal cancer screening.…”

“…[10][11][12][13][14][15][16][17][18][19][20][21][22] Whether enhancement of sociopsychological factors influences health behaviors is uncertain. 12,13,19,[22][23][24][25][26][27][28][29][30][31][32] Among trials comparing patients receiving sociopsychologically tailored colorectal cancer screening interventions with active control, 15,19,20,22,[25][26][27][28][29][30]33 only some found superior effects of tailoring 19,25,28,29,34 ; in all but 1 trial 34 screening was self-reported, 19,25,28,29 suggesting possible response bias. There is a need to examine further whether objectively measured colorectal cancer screening improves in response to sociopsychologi...…”

Predicting Colonoscopy Completion Among African American and Latino/a Participants in a Patient Navigation Program

“…These items asked how strongly participants agreed or disagreed (on a five-point Likert-type scale) with statements about the cons of having a colonoscopy (e.g., “I would probably not have a colonoscopy if I had to have laxatives.”). There are six items in the previously published Fear of Colonoscopy Likert-type scale [31]. On a scale of one to five, participants were asked to rate how fearful they felt about issues related to colonoscopy (including the procedure, the preparation, etc.).…”