Telephone versus in‐person colorectal cancer risk and screening intervention for first‐degree relatives: A randomized controlled trial

• Published in: Cancer 2019-07, Vol.125 (13), p.2272-2282
• Main Authors: Esplen, Mary Jane, Harrington, Sarah, Leung, Yvonne W., Aronson, Melyssa, Rothenmund, Heidi, Semotiuk, Kara, Wong, Jiahui, Gallinger, Steven, Dicks, Elizabeth, McLaughlin, John
• Format: Article
• Language: English
• Subjects: Adhesion; Cancer; Clinical trials; Colonoscopy - methods; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - psychology; Counseling; Counseling - methods; Early Detection of Cancer - methods; Family - psychology; Female; Follow-Up Studies; genetic counseling; Genetics; Health risks; Humans; Intervention; intervention research; Knowledge; Male; Middle Aged; Mutation; Oncology; Prognosis; Randomization; randomized controlled trial; relatives; Risk analysis; Risk factors; Risk perception; Risk taking; Screening; Social interactions; Statistical analysis; Telephone - statistics & numerical data
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.32032

Background 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. Methods 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). Results 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. Conclusions 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. In the current study, first‐degree relatives of patients with colorectal cancer are found to overestimate their risk of developing the disease. Both the in‐person and telephone‐based educational/counseling interventions improve colorectal cancer knowledge and risk perceptions, and neither appears to be associated with increased distress after the intervention.