title: Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial.
abstract: OBJECTIVE
  Only 12-49% of colorectal cancer (CRC) patients and their first-degree relatives with an increased familial CRC risk are referred for cancer prevention measures (surveillance colonoscopies or genetic counselling). The study was performed to evaluate the effectiveness and feasibility of a novel strategy to improve the uptake of genetic counselling for high risk individuals and surveillance colonoscopy for moderate risk groups.
  
  
  METHODS
  Eighteen hospitals participated in a clustered randomized controlled trial. Patients in nine hospitals received usual care (group A). Nine other hospitals received the novel strategy (group B) including access to a website for patients and clinicians, patient-targeted brochures and clinician-targeted education and pocket referral cards. Data before and after dissemination of the strategy were collected from questionnaires and medical records.
  
  
  RESULTS
  Data were complete for 358 (44%) of 820 CRC patients and 50 (36%) of 137 clinicians before dissemination of the strategy and 392/862 patients (45%) and 47/137 clinicians (34%) after. Referral for cancer prevention measures was assessed at a median of 8 (2-12) months after CRC diagnosis in groups A and B before the dissemination of the strategy and in group A after. In group B referral was assessed at a median of 9 (4-11) months after the dissemination of the strategy. Uptake of genetic counselling by high risk patients was equal in groups A and B, being 33% before and 15% after (P = 0.003). Uptake of surveillance colonoscopy by moderate risk relatives did not change significantly (group A, 36% before vs 41% after; group B, 33% before vs 19% after). In group B 94/140 patients (67%) and 25/72 clinicians (35%) visited the website and 34/140 (24%) patients read the brochure. Patients valued clinicians' information as most useful, followed by the patient brochure. Clinicians preferred pocket cards and education.
  
  
  CONCLUSIONS
  Our strategy did not improve referral for cancer prevention measures. Although the newly offered strategy elements were appreciated, patients preferred clinicians' advice regarding referral for cancer prevention measures. It may be useful to aim future interventions at healthcare professionals rather than patients to improve the prevention of familial cancer.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.|Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Dekker
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: R P
authors.initials: RP
authors.lastname: Hermens
authors.affiliation: Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: de Wilt
authors.affiliation: Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: van Zelst-Stams
authors.affiliation: Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.|Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Hoogerbrugge
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000235:genetics / Q000517:prevention & control*; D005190:Family; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods
keywords: Colorectal cancer; familial risk; guidelines; implementation