title: Effects of genetic and environmental risk assessment feedback on colorectal cancer screening adherence.
abstract: Little is known about the impact of genetic and environmental risk assessment (GERA) feedback on colorectal cancer (CRC) screening. In a recently completed randomized trial, primary care patients received GERA feedback based on a blood test for genetic polymorphisms and serum folate level (GERA Group) versus usual care (Control Group). Subsequently, participants were offered CRC screening. Among participants who received GERA feedback, being at elevated risk was negatively associated with prospective CRC screening adherence. Secondary analyses of data from this study were performed to identify independent predictors of adherence among participants who received GERA feedback. We obtained baseline survey, follow-up survey, and endpoint medical records data on sociodemographic background, knowledge, psychosocial characteristics, risk status, and adherence for 285 GERA Group participants. Univariate and multivariable analyses were performed to identify predictors of CRC screening adherence. Following a 6-month outcomes observation period, we also conducted two focus groups with GERA Group participants to assess their perceptions of GERA risk feedback and screening. Content analyses of focus group data were evaluated to gain insights into participant response to risk feedback. Overall, half of GERA Group participants adhered to screening within 6 months after randomization. Multivariable analyses showed a statistically significant interaction between race and GERA feedback status relative to screening adherence (p = 0.043). Among participants who received average risk feedback, adherence was comparable among whites (49.7 %) and nonwhites (54.1 %); however, among those at elevated risk, adherence was substantially higher among whites (66.7 %) compared to nonwhites (33.3 %). Focus group findings suggest that whites were more likely than nonwhites to view elevated risk feedback as a prompt to screen. In response to receiving elevated risk feedback, nonwhites were more likely than whites to report feeling anxiety about the likelihood of being diagnosed with CRC. Further research is needed to explore race-related CRC screening differences in response to GERA feedback.
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA. ronald.myers@jefferson.edu.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.affiliation: Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Manne
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Cocroft
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Randa
authors.initials: R
authors.lastname: Sifri
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Ziring
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Desiree
authors.initials: D
authors.lastname: Burgh
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Ross
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Weinberg
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D044465:White People
keywords: Adherence; Cancer; Colorectal; Environment; Genetic; Risk assessment; Screening