title: Colonoscopy uptake for high-risk individuals with a family history of colorectal neoplasia: A multicenter, randomized trial of tailored counseling versus standard information.
abstract: BACKGROUND
  Colonoscopic screening is recommended for first-degree relatives of patients diagnosed with colorectal cancer (CRC) or colorectal adenomatous polyps (CAP) before the age of 60 years. This has the potential to reduce CRC-related morbidity and mortality, but uptake is currently inadequate.
  
  
  METHODS
  The aim of the study was to compare the effectiveness of standard information versus a nurse-led tailored intervention designed to promote uptake of colonoscopy screening by siblings of CRC or CAP patients. A randomized controlled trial was conducted. Digestive surgeons and gastroenterologists recruited index patients who developed CRC or CAP before the age of 60 years. All index patients received standard screening information for their siblings, in keeping with current guidelines. Centrally computerized randomization of index patients resulted in allocating all their siblings to the same group, intervention or control. The tailored intervention targeted the index patient first, to help them convey information to their siblings. The nurse then provided the siblings with tailored information based on their answers to a self-questionnaire which explored health behaviors, derived from psychosocial models of prevention. Then the siblings were given a personalized information leaflet to hand to their regular physician. The primary endpoint was the rate of documented colonoscopy performed in siblings within 1 year after diagnosis of the index patient. The intent-to-treat analysis included siblings who refused to participate in the study. Statistical analysis was adjusted for intrafamilial correlation.
  
  
  RESULTS
  A total of 304 siblings of 125 index patients were included: 160 in the intervention group and 144 in the control group. The rate of colonoscopy uptake among siblings was 56.3% in the intervention group and 35.4% in the control group (P = 0.0027). The respective rates after exclusion of refusals were 69.2% and 37.0% (P < 0.0001). More lesions were detected in the intervention group (1 invasive cancer and 11 advanced adenomas vs 5 advanced adenomas; P = 0.022).
  
  
  CONCLUSIONS
  This study demonstrates the effectiveness of a nurse-led tailored intervention designed to promote colonoscopy screening uptake by siblings of patients diagnosed with CRC or CAP before age 60 years. Such tailored interventions that also involve physicians should help to reduce CRC-related mortality.
authors.affiliation: INSERM, CIC-1402 Unité d'épidémiologie et de biostatistique-Registre des cancers de Poitou-Charentes, Université de Poitiers Pôle Santé Publique Service de Chirurgie Digestive Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Poitiers, Poitiers Groupe de Recherches et d'Etudes Sociologiques du Centre-Ouest (GRESCO) CREGG, Club de réflexion des cabinets et groupe de gastroentérologues, Polyclinique de Poitiers, Poitiers, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ingrand
authors.forename: Gautier
authors.initials: G
authors.lastname: Defossez
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Richer
authors.forename: David
authors.initials: D
authors.lastname: Tougeron
authors.forename: Nicolas
authors.initials: N
authors.lastname: Palierne
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Letard
authors.forename: Michel
authors.initials: M
authors.lastname: Beauchant
authors.forename: Pierre
authors.initials: P
authors.lastname: Ingrand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis / Q000235:genetics; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics; D003376:Counseling / Q000379:methods; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D012307:Risk Factors; D035781:Siblings; D011795:Surveys and Questionnaires; D055815:Young Adult