de Souza Institute, University Health Network, Toronto, Ontario, Canada.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2019 Jul 1;125(13):2272-2282. doi: 10.1002/cncr.32032. Epub 2019 Mar 12.
Having a first-degree relative (FDR) with colorectal cancer (CRC) is a significant risk factor for CRC. Counseling for FDRs regarding CRC risk factors and personalized risk is important to improve knowledge and screening compliance.
A 3-arm randomized controlled trial compared tailored in-person and telephone CRC counseling interventions with controls among FDRs who were not mutation carriers for known hereditary cancer syndromes, but who were considered to be at an increased risk based on family history. It was hypothesized that both telephone and in-person approaches would increase CRC knowledge, screening adherence, perceived risk accuracy, and psychosocial functioning compared with controls. The authors anticipated greater satisfaction with the in-person approach. CRC knowledge, risk perception, psychosocial functioning, and intention to screen were assessed at baseline and at 2-week and 2-month follow-ups (primary endpoint).
A total of 278 FDRs (mean age, 47.4 years, standard deviation, 11.38 years) participated. At baseline, participants reported low to moderate CRC knowledge and overestimations of risk. Screening adherence was 73.7%. At 2 months, participants in the in-person arm and telephone arm demonstrated improvements in knowledge and perceived risk and were not found to be statistically different from each other. However, when comparing each intervention with controls, knowledge in the in-person arm was found to be statistically significantly higher, but the difference between the telephone and control arms was not. Cancer-related stress reduced over time in all groups. Intervention benefits were maintained at 1 year. Baseline screening intent/adherence were high, and therefore did not reach statistically significant improvement.
Tailored in-person or telephone formats for providing CRC risk counseling, incorporating behavioral interventions, appear to improve knowledge and risk perceptions, with high client satisfaction.
一级亲属（FDR）患有结直肠癌（CRC）是 CRC 的重要危险因素。对 FDR 进行 CRC 危险因素和个性化风险咨询对于提高知识水平和筛查依从性很重要。
一项三臂随机对照试验比较了针对非已知遗传性癌症综合征突变携带者但基于家族史被认为风险增加的 FDR 的定制面对面和电话 CRC 咨询干预与对照组。假设与对照组相比，电话和面对面方法都将增加 CRC 知识、筛查依从性、感知风险准确性和心理社会功能。作者预计面对面方法会更满意。在基线以及 2 周和 2 个月的随访（主要终点）时评估 CRC 知识、风险感知、心理社会功能和筛查意向。
共有 278 名 FDR 参与（平均年龄为 47.4 岁，标准差为 11.38 岁）。在基线时，参与者报告了低至中等水平的 CRC 知识和风险高估。筛查依从率为 73.7%。在 2 个月时，面对面组和电话组的参与者在知识和感知风险方面均有所改善，且彼此之间无统计学差异。然而，当将每种干预与对照组进行比较时，面对面组的知识明显更高，但电话组与对照组之间的差异则不显著。所有组的癌症相关压力随着时间的推移而降低。干预效果在 1 年内得以维持。基线筛查意向/依从性较高，因此未达到统计学显著改善。
提供 CRC 风险咨询的定制面对面或电话格式，结合行为干预，似乎可以提高知识和风险感知，同时客户满意度也很高。
