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.
J Clin Oncol. 2014 Mar 1;32(7):654-62. doi: 10.1200/JCO.2013.51.6765. Epub 2014 Jan 21.
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.
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.
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.
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.
在结直肠癌（CRC）家族患病风险增加的个体中，定期接受结肠镜筛查的依从率不理想，尤其是在农村和其他地理服务不足的人群中。远程干预措施可能克服地理和系统层面的障碍。我们比较了基于远程医疗的个性化风险评估和沟通干预与邮寄教育手册对改善 CRC 患者高危亲属结肠镜筛查的效果。
在联系五个州的 CRC 患者或其近亲后，招募了年龄在 30 岁至 74 岁之间、未接受适当风险筛查且不符合基因检测条件的合格个体。将符合条件的个体按家庭单位随机分配到积极的个性化干预组或邮寄教育手册组。主要结局是干预后 9 个月内进行医学验证的结肠镜检查。
在 481 名符合条件且随机分配的高危亲属中，79.8%在 9 个月内完成了结局评估；个性化干预组中有 35.4%的人进行了结肠镜检查，而对照组中只有 15.7%的人进行了结肠镜检查。意向治疗分析显示，远程医疗组接受筛查的可能性几乎是低强度对照组的三倍（比值比，2.83；95%置信区间，1.87 至 4.28；P<0.001）。农村地区和收入较低的人群与城市居民一样受益。
考虑家族史并纳入基于证据的风险沟通和行为改变策略的远程个性化干预措施，可能会促进 CRC 患者的密切亲属进行适当风险的筛查。
