The rate of adherence to regular colonoscopy screening among members of families at increased risk forcolorectal cancer (CRC) is far below recommended levels. Persons who live in rural areas of the United Statesexhibit lower colorectal screening rates than their urban counterparts. Although the detection of familialpredisposition to cancer begins with an accurate family medical history, data indicate that many patients do notreceive adequate familial cancer risk assessment from their primary care providers. This suggests that familialrisk is largely unrecognized which may lead to inadequate risk stratification, lack of risk notification, appropriaterisk counseling, suboptimal cancer screening and preventable deaths. Because of geographic and system-level barriers, special efforts are needed to improve access to personalized risk communication and adherenceto CRC screening in rural dwellers at increased risk for CRC. In the proposed study, we will evaluate a noveltelephone-based, theory-guided personalized risk communication intervention that combines a familial CRCrisk assessment and behavioral counseling with tailored messages. The key hypothesis guiding this study isthat a more intensive personalized risk communication intervention will improve CS at a significantly higherrate than a low-intensity targeted print intervention. Our integrative study model specifies important theoreticalmechanisms that can contribute to increased use of CS among persons at increased risk. We will enroll 712rural adult men and women age 40 years and older who are considered at increased risk of familial CRC intothis 2-group randomized trial. The primary aim of this study is to compare colonoscopy use among participantsin the two groups. Secondary aims are to compare the two groups with regard to cognitive and emotionaloutcomes and explore the underlying mechanisms through which the interventions have an impact oncolonoscopy behavior. Sociodemographic, clinical, behavioral and psychosocial measures will be collectedfrom participants at baseline, 1 month, 6 months and 1 year. The study's findings will have both theoretical, aswell as practical, significance. Our findings will help to influence the selection and dissemination of effectiveoutreach approaches to improve CRC screening in populations at increased risk for the disease. These resultshave broad applicability to understanding responses to personalized risk communication interventions for otherdiseases as well. Findings will also broaden our understanding of the underlying theoretical mechanisms ofhow remote cancer risk communications lead to improvements in cancer screening among geographicallyunderserved populations if such intervention effects are observed
Provision of personalized risk assessment and behavioral counseling services via the telephone is likely toensure equitable access to cancer communications for rural and other underserved groups. Such interventionshave the potential to translate into improved colorectal cancer (CRC) screening rates among rural dwellers atincreased risk for the disease by removing geographic and other barriers to accessing potentially life-savingcancer risk communications. Our study is highly responsive to national health communication and healthdisparity priorities; and will provide data that are needed to influence the development and dissemination ofeffective cancer communication interventions to high-risk individuals who reside in geographically underservedareas.
