Ingrand Isabelle, Gaussot Ludovic, Richard Elisabeth, Drouet Griselda, Moreau Fabienne, Ingrand Pierre
Sante Publique. 2019;S2(HS2):79-89. doi: 10.3917/spub.197.0079.
Information on risk levels is an essential part of the prevention of colorectal cancer (CRC). The objective of this article is to describe a tailored intervention carried out to inform the protagonists about the high risk of CRC due to family history and then to understand, through an interdisciplinary analysis, the mechanisms implemented during the intervention.
A randomized trial design was applied. The primary outcome was the colonoscopy uptake. The intervention concerned firstly the index patients with CRC or adenoma to advise and accompany them in the transmission of information about the elevated risk for their siblings. The siblings received tailored counselling carried out by a preventive nurse, by telephone then by mail. Epidemiological, linguistic and sociological cross-analyzes were carried out to understand the impact of the intervention.
Colonoscopy rate was 56.3% in the intervention group, 35.4% in the control group (P = 0.0027; 304 siblings). The linguistic analysis of recorded nurse's interventions showed that, following the intervention (N = 59), the prevention themes were better assimilated while they remained vague and questioned in the discourse of the control siblings who had carried out the colonoscopy (N = 8). That was confirmed by the sociological analysis (four families) which also revealed the importance of information received from a health professional and of communication within families.
The study showed the impact of transmission of information to convince siblings at high risk of CRC to carry out colonoscopy.
风险水平信息是预防结直肠癌（CRC）的重要组成部分。本文的目的是描述一项针对性干预措施，该措施旨在让相关人员了解因家族病史导致的患CRC高风险，然后通过多学科分析来了解干预过程中所采用的机制。
采用随机试验设计。主要结局是结肠镜检查的接受率。干预首先针对患有CRC或腺瘤的索引患者，为他们提供建议并陪伴他们向其兄弟姐妹传达患病风险升高的信息。其兄弟姐妹接受了由预防护士提供的针对性咨询，先是通过电话，然后是通过邮件。进行了流行病学、语言和社会学交叉分析，以了解干预的影响。
干预组的结肠镜检查率为56.3%，对照组为35.4%（P = 0.0027；304名兄弟姐妹）。对护士记录的干预措施进行的语言分析表明，在干预之后（N = 59），预防主题得到了更好的理解，而在进行了结肠镜检查的对照组兄弟姐妹的话语中（N = 8），这些主题仍然模糊且受到质疑。社会学分析（四个家庭）证实了这一点，该分析还揭示了从医疗专业人员那里获得的信息以及家庭内部沟通的重要性。
该研究表明了信息传递对说服有CRC高风险的兄弟姐妹进行结肠镜检查的影响。
