First-degree relatives of people who have been diagnosed with colorectal adenomatous polyps (CAP) have a two-fold-increased risk of developing colorectal cancer (CRC). Regular endoscopic screening with flexible sigmoidoscopy or colonoscopy leads to removal of precancerous polyps, which has been shown to decrease CRC incidence by 75% to 90%. Tailored telephone counseling, one specific type of telehealth intervention has demonstrated considerable promise as an intervention that motivates people to change health behaviors. The purpose of the proposed study is to compare the effectiveness of two interventions, a tailored telephone counseling intervention and a nontailored print intervention, designed to increase participation in CRC with sigmoidoscopy or colonoscopy. The nontailored intervention will be an American Cancer Society health education booklet that contains messages about colorectal cancer, risk factors, screening recommendations, and screening tests. The tailored telephone counseling intervention will be delivered by trained nurses and will contain individually tailored messages for each participant based on baseline assessment of their individual demographics, CRC risk factors, Health Belief Model constructs (perceived risks, benefits, barriers, self-efficacy), and stages of change for sigmoidoscopy or colonoscopy. This study contrasts two groups of first-degree relatives (FDRs) who will be randomly assigned to the tailored telephone intervention arm or the nontailored intervention arm. Participants will be 220 FDRs (110 in each arm) who were referred by family members diagnosed with CAP. Data will be collected via structured telephone interviews at baseline, prior to randomization, and at 3 months post-baseline. Behavioral outcomes will be measured dichotomously by whether participants have has a sigmoidoscopy or colonoscopy and by stages of change for sigmoidoscopy or colonoscopy based on Prochaska and DiClemente's Transtheoretical Model. Both process and outcome evaluations are planned. Primary analyses of screening participation outcomes will use Fischer's exact test to compare proportions of participants who report being screened with sigmoidoscopy or colonoscopy at follow-up. Logistic regression will be used to examine other potential predictors of screening participation. Stages of change will be tested using ordinal logistic regression with group as the predictor for each screening test.
| Rawl, Susan M; Christy, Shannon M; Monahan, Patrick O et al. (2015) Tailored telephone counseling increases colorectal cancer screening. Health Educ Res 30:622-37 |
