title: Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective.
abstract: BACKGROUND
  Family history is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers' current practice relating to: (i) assessment of family history of CRC; (ii) notification of "increased risk" to patients at "moderately/potentially high" familial risk; and (iii) recommendation that patients undertake CRC screening.
  
  
  METHODS
  1592 persons aged 56-88 years randomly selected from the Hunter Community Study (HCS), New South Wales, Australia were mailed a questionnaire. 1117 participants (70%) returned a questionnaire.
  
  
  RESULTS
  Thirty eight percent of respondents reported ever being asked about their family history of CRC. Ever discussing family history of CRC with a health care provider was significantly more likely to occur for persons with a higher level of education, who had ever received screening advice and with a lower physical component summary score. Fifty one percent of persons at "moderately/potentially high risk" were notified of their "increased risk" of developing CRC. Thirty one percent of persons across each level of risk had ever received CRC screening advice from a health care provider. Screening advice provision was significantly more likely to occur for persons who had ever discussed their family history of CRC with a health care provider and who were at "moderately/potentially high risk".
  
  
  CONCLUSIONS
  Effective interventions that integrate both the assessment and notification of familial risk of CRC to the wider population are needed. Systematic and cost-effective mechanisms that facilitate family history collection, risk assessment and provision of screening advice within the primary health care setting are required.
authors.affiliation: The Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, Australia. ryan.courtney@newcastle.edu.au
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Courtney
authors.forename: Christine L
authors.initials: CL
authors.lastname: Paul
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sanson-Fisher
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.forename: Mariko L
authors.initials: ML
authors.lastname: Carey
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003153:Community Health Services; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000592:standards*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D018570:Risk Assessment / Q000592:standards; D011795:Surveys and Questionnaires