Advertisement

Colorectal cancer patients advocating screening to their siblings: a randomized behavioral intervention

Published:December 09, 2021DOI:https://doi.org/10.1016/j.gie.2021.11.042

      Background and Aims

      Siblings of colorectal cancer (CRC) patients are at increased risk of developing CRC, but screening rates remain low. Through a randomized behavioral intervention, this study aimed to determine whether patients can advocate screening to their siblings using a tailored educational package.

      Methods

      CRC survivors were recruited and randomized into relaying either tailored materials (intervention group) or existing national screening guidelines (control group) to their siblings. Siblings could respond to the study team if they were interested in learning about CRC screening. Study outcomes were patient advocacy rates (number of patients who had successfully contacted at least 1 eligible sibling) between groups and the proportion of eligible siblings who responded.

      Results

      Between May 2017 and March 2021, 219 CRC patients were randomized to the intervention (n = 110) and control (n = 109) groups. Patient advocacy rates were high and did not differ significantly between groups. However, only 14.3% of eligible siblings (n = 85) responded to the study team. Siblings of patients from the intervention group were more likely to respond (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0; P < .05). Moreover, after controlling for potential confounders, siblings aged ≥60 years were significantly less likely to respond (adjusted odds ratio, .3; 95% confidence interval, .1-.7; P < .01).

      Conclusions

      CRC patients are willing advocates of screening, and siblings contacted by patients from the intervention group were also more likely to reach out to the study team. However, overall sibling response rates were low despite advocacy, suggesting that patient-led advocacy should at best be used as an adjunct to other, multipronged CRC screening promotion modalities.

      Graphical abstract

      Abbreviations:

      CRC (colorectal cancer), FDR (first-degree relative), PDPA (Personal Data Protection Act)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Health Promotion Board NRDO
        Singapore Cancer Registry annual report 2018 National Registry of Diseases Office (NRDO) 2021.
        (Available at:) (Accessed November 17, 2021)
        • Wong M.C.
        • Ding H.
        • Wang J.
        • et al.
        Prevalence and risk factors of colorectal cancer in Asia.
        Intest Res. 2019; 17: 317-329
        • Butterworth A.S.
        • Higgins Jp
        • Fau-Pharoah P.
        • et al.
        Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis.
        Eur J Cancer. 2006; 42: 216-227
        • Baglietto L.
        • Jenkins M.A.
        • Severi G.
        • et al.
        Measures of familial aggregation depend on definition of family history: meta-analysis for colorectal cancer.
        J Clin Epidemiol. 2006; 59: 114-124
        • Samadder N.J.
        • Smith K.R.
        • Mineau G.P.
        • et al.
        Familial colorectal cancer risk by subsite of primary cancer: a population-based study in Utah.
        Aliment Pharmacol Ther. 2015; 41: 573-580
        • Samadder N.J.
        • Curtin K.
        • Tuohy T.M.F.
        • et al.
        Increased risk of colorectal neoplasia among family members of patients with colorectal cancer: a population-based study in Utah.
        Gastroenterology. 2014; 147: 814-821
        • Johns L.E.
        • Houlston R.S.
        A systematic review and meta-analysis of familial colorectal cancer risk.
        Am J Gastroenterol. 2001; 96: 2992-3003
        • Lieberman D.A.
        • Rex D.K.
        • Winawer S.J.
        • et al.
        Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2012; 143: 844-857
        • Shaukat A.
        • Kahi C.J.
        • Burke C.A.
        • et al.
        ACG clinical guidelines: colorectal cancer screening 2021.
        Am J Gastroenterol. 2021; 116: 458-479
        • Ruthotto F.
        • Papendorf F.
        • Wegener G.
        • et al.
        Participation in screening colonoscopy in first-degree relatives from patients with colorectal cancer.
        Ann Oncol. 2007; 18: 1518-1522
        • Tan K.K.
        • Lim T.Z.
        • Chan D.K.H.
        • et al.
        Getting the first degree relatives to screen for colorectal cancer is harder than it seems—patients' and their first degree relatives' perspectives.
        Int J Colorectal Dis. 2017; 32: 1065-1068
        • Wong R.K.
        • Wong M.L.
        • Chan Y.H.
        • et al.
        Gender differences in predictors of colorectal cancer screening uptake: a national cross sectional study based on the health belief model.
        BMC Public Health. 2013; 13: 677
        • Ministry of Health Singapore
        Fee benchmarks and bill amount information. Lower abdomen, scope of large intestine with or without biopsy for diagnosis. Ministry of Health, Singapore; 2021.
        (Available at:) (Accessed November 17, 2021)
        • Tan K.K.
        • Lim T.Z.
        • Chew E.
        • et al.
        Colorectal cancer patients can be advocates for colorectal cancer screening for their siblings: a study on siblings' perspectives.
        Psychooncology. 2020; 29: 2028-2032
        • Ingrand I.
        • Defossez G.
        • Richer J.P.
        • et al.
        Colonoscopy uptake for high-risk individuals with a family history of colorectal neoplasia: a multicenter, randomized trial of tailored counseling versus standard information.
        Medicine (Baltimore). 2016; 95e4303
        • Bastani R.
        • Glenn B.A.
        • Maxwell A.E.
        • et al.
        Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives.
        Cancer. 2015; 121: 2951-2959
        • Manne S.L.
        • Coups E.J.
        • Markowitz A.
        • et al.
        A randomized trial of generic versus tailored interventions to increase colorectal cancer screening among intermediate risk siblings.
        Ann Behav Med. 2009; 37: 207-217
        • Carey M.
        • Sanson-Fisher R.
        • Macrae F.
        • et al.
        Can a print-based intervention increase screening for first degree relatives of people with colorectal cancer? A randomised controlled trial.
        Aust N Z J Public Health. 2016; 40: 582-587
        • Lowery J.T.
        • Horick N.
        • Kinney A.Y.
        • et al.
        A randomized trial to increase colonoscopy screening in members of high-risk families in the colorectal cancer family registry and cancer genetics network.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 601-610
        • Kinney A.Y.
        • Boonyasiriwat W.
        • Walters S.T.
        • et al.
        Telehealth personalized cancer risk communication to motivate colonoscopy in relatives of patients with colorectal cancer: the family CARE randomized controlled trial.
        J Clin Oncol. 2014; 32: 654-662
        • Rawl S.M.
        • Champion V.L.
        • Scott L.L.
        • et al.
        A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives.
        Patient Educ Couns. 2008; 71: 215-227
        • Stephens J.H.
        • Moore J.W.
        Can targeted intervention in CRC patients' relatives influence screening behaviour? A pilot study.
        Colorectal Dis. 2008; 10: 179-186
        • Singapore Statutes Online. Supplement ROSGGA
        Personal Data Protection Act 2012: Singapore statutes online; 2012.
        (Available at:) (Accessed November 17, 2021)
        • Department of Statistics Singapore
        Population trends 2015.
        (Available at:) (Accessed November 17, 2021)
        • Singapore Ministry of Health
        Cancer screening MOH clinical practice guidelines 1/2010.
        (Available at:) (Accessed November 17, 2021)
        • Bai Y.
        • Wong C.L.
        • He X.
        • et al.
        Effectiveness of tailored communication intervention in increasing colonoscopy screening rates amongst first-degree relatives of individuals with colorectal cancer: a systematic review and meta-analysis.
        Int J Nurs Stud. 2020; 101: 103397
        • Marcus A.C.
        • Mason M.
        • Wolfe P.
        • et al.
        The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute's Cancer Information Service.
        J Health Commun. 2005; 10: 83-104
        • Dancyger C.
        • Wiseman M.
        • Jacobs C.
        • et al.
        Communicating BRCA1/2 genetic test results within the family: a qualitative analysis.
        Psychol Health. 2011; 26: 1018-1035
        • Glanz K.
        • Steffen A.D.
        • Taglialatela L.A.
        Effects of colon cancer risk counseling for first-degree relatives.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 1485-1491
        • Madlensky L.
        • Esplen M.J.
        • Gallinger S.
        • et al.
        Relatives of colorectal cancer patients: factors associated with screening behavior.
        Am J Prev Med. 2003; 25: 187-194
        • Northouse L.L.
        • Schafer J.A.
        • Tipton J.
        • et al.
        The concerns of patients and spouses after the diagnosis of colon cancer: a qualitative analysis.
        J Wound Ostom Cont Nurs. 1999; 26: 8-17