Telehealth personalized cancer risk communication to motivate colonoscopy in relatives of patients with colorectal cancer: the family CARE Randomized controlled trial.
OBJECTIVE
The rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer (CRC) is suboptimal, especially among rural and other geographically underserved populations. Remote interventions may overcome geographic and system-level barriers. We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC.


METHODS
Eligible individuals age 30 to 74 years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states. Enrollees were randomly assigned as family units to either an active, personalized intervention that incorporated evidence-based risk communication and behavior change techniques, or a mailed educational brochure. The primary outcome was medically verified colonoscopy within 9 months of the intervention.


RESULTS
Of the 481 eligible and randomly assigned at-risk relatives, 79.8% completed the outcome assessments within 9 months; 35.4% of those in the personalized intervention group and 15.7% of those in the comparison group obtained a colonoscopy. In an intent-to-treat analysis, the telehealth group was almost three times as likely to get screened as the low-intensity comparison group (odds ratio, 2.83; 95% CI, 1.87 to 4.28; P < .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents.


CONCLUSIONS
Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.
Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL.
Anita Y
AY
Kinney
Watcharaporn
W
Boonyasiriwat
Scott T
ST
Walters
Lisa M
LM
Pappas
Antoinette M
AM
Stroup
Marc D
MD
Schwartz
Sandra L
SL
Edwards
Amy
A
Rogers
Wendy K
WK
Kohlmann
Kenneth M
KM
Boucher
Sally W
SW
Vernon
Rebecca G
RG
Simmons
Jan T
JT
Lowery
Kristina
K
Flores
Charles L
CL
Wiggins
Deirdre A
DA
Hill
Randall W
RW
Burt
Marc S
MS
Williams
John C
JC
Higginbotham
D000328:Adult; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D057285:Precision Medicine / Q000379:methods*; D018570:Risk Assessment; D012424:Rural Population; D017216:Telemedicine