Comparative Effectiveness of Two Interventions to Increase Colorectal Cancer Screening for Those at Increased Risk Based on Family History: Results of a Randomized Trial

Abstract

Background: First-degree relatives (FDR) of patients with colorectal cancer are at risk for colorectal cancer, but may not be up to date with colorectal cancer screening. We sought to determine whether a one-time recommendation about needing colorectal cancer screening using patient navigation (PN) was better than just receiving the recommendation only.Methods: Participants were FDRs of patients with Lynch syndrome-negative colorectal cancer from participating Ohio hospitals. FDRs from 259 families were randomized to a website intervention (528 individuals), which included a survey and personal colorectal cancer screening recommendation, while those from 254 families were randomized to the website plus telephonic PN intervention (515 individuals). Primary outcome was adherence to the personal screening recommendation (to get screened or not to get screened) received from the website. Secondary outcomes examined who benefited from adding PN.Results: At the end of the 14-month follow-up, 78.6% of participants were adherent to their recommendation for colorectal cancer screening with adherence similar between arms (P ¼ 0.14). Among those who received a recommendation to have a colonoscopy immediately, the website plus PN intervention significantly increased the odds of receiving screening, compared with the website intervention (OR: 2.98; 95% confidence interval, 1.68-5.28).Conclusions: Addition of PN to a website intervention did not improve adherence to a colorectal cancer screening recommendation overall; however, the addition of PN was more effective in increasing adherence among FDRs who needed screening immediately.Impact: These findings provide important information as to when the additional costs of PN are needed to assure colorectal cancer screening among those at high risk for colorectal cancer.

Adapting genetic counseling operations amidst the COVID‐19 pandemic

“…On the day of each clinic, GCs called the patients who committed to a telephone consultation at their assigned time. The literature suggests that multiple attempts to contact patients result in better adherence to appointments, and as such, GCs not assigned to a patient within each 30‐min block called patients who were not reached previously in an attempt to conduct a “live” genetic counseling session (Ayanian et al., 2008 ; Childers et al., 2016 ; Grimes et al., 2019 ; Jones et al., 2020 ; Kerrison et al., 2017 ; Menees et al., 2010 ; Paskett et al., 2020 ; Posadzki et al., 2016 ). If the patient was reached, the GC would provide a hereditary cancer risk assessment.…”

Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities

“…102 Although few interventions have targeted uptake and adherence of risk-reducing care in patients with hereditary cancer syndromes, insights can be drawn from interventions to improve adherence to cancer risk-reducing treatment in other high-risk populations, such as individuals with a first-degree relative with colorectal cancer (CRC). Some promising strategies, including patient navigation 103 and judicious use of fecal immunochemical tests (FITs) rather than colonoscopy, 104 warrant exploration as options for hereditary cancer syndromes. Although FIT would not be an appropriate alternative for syndromes where polyp excision is a cornerstone of risk reduction, FIT or FIT-DNA could be examined for LS-related CRC detection as an adjunct to colonoscopy screenings and for patients unable to undergo regular colonoscopy.…”

Effect of Behavioral Interventions on the Uptake of Colonoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis

“…Twenty-one studies were randomized controlled trials and 6 were population-based (13)(14)(15)(16)(17)(18). Several studies focused on specific populations: 6 involved lowincome or racial minority groups in the United States (19)(20)(21)(22)(23)(24), 3 examined individuals with first-degree relatives with CRC (17,18,25), and 1 studied persons with human immunodeficiency virus (26). Six studies included patients younger than 50 years (15,17,18,22,25,27).…”

“…Several studies focused on specific populations: 6 involved lowincome or racial minority groups in the United States (19)(20)(21)(22)(23)(24), 3 examined individuals with first-degree relatives with CRC (17,18,25), and 1 studied persons with human immunodeficiency virus (26). Six studies included patients younger than 50 years (15,17,18,22,25,27). For behavioral interventions, 3 interventions used mailed letters (13,16,28), 3 used informational brochures (24,29), 11 studied patient navigation (17)(18)(19)(20)(21)23,25,(30)(31)(32), 1 examined preprocedural telephone consultations ( 14), 1 studied PCP counseling (33), 2 used videos (22,26), 1 changed EHR settings (10), 1 used an email intervention (34), and 1 used a financial incentive (35).…”