Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial

Autor: R. Hermens, Grard Nieuwenhuijzen, Frits Berends, Nicoline Hoogerbrugge, Evelien Dekker, Joannes Van Krieken, Glyn Elwyn
Přispěvatelé: Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Gastroenterology and Hepatology
Rok vydání: 2015
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
Referral
Colorectal cancer
Genetic counseling
Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2]
Psychological intervention
Genetic Counseling
Health Promotion
Risk Assessment
Group B
law.invention
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
Randomized controlled trial
law
medicine
Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14]
Cluster Analysis
Humans
Mass Screening
Family
Genetic Predisposition to Disease
Referral and Consultation
Cancer prevention
business.industry
Medical record
Gastroenterology
Colonoscopy
Middle Aged
medicine.disease
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
Female
Colorectal Neoplasms
business
Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Zdroj: Colorectal Disease, 17, 6, pp. 499-510
Colorectal disease, 17(6), 499-510. Wiley-Blackwell
Colorectal Disease, 17, 499-510
ISSN: 1462-8910
Popis: Contains fulltext : 153120.pdf (Publisher’s version ) (Closed access) AIM: Only 12-49% of colorectal cancer (CRC) patients and their first-degree relatives with an increased familial CRC risk are referred for cancer prevention measures (surveillance colonoscopies or genetic counselling). The study was performed to evaluate the effectiveness and feasibility of a novel strategy to improve the uptake of genetic counselling for high risk individuals and surveillance colonoscopy for moderate risk groups. METHOD: Eighteen hospitals participated in a clustered randomized controlled trial. Patients in nine hospitals received usual care (group A). Nine other hospitals received the novel strategy (group B) including access to a website for patients and clinicians, patient-targeted brochures and clinician-targeted education and pocket referral cards. Data before and after dissemination of the strategy were collected from questionnaires and medical records. RESULTS: Data were complete for 358 (44%) of 820 CRC patients and 50 (36%) of 137 clinicians before dissemination of the strategy and 392/862 patients (45%) and 47/137 clinicians (34%) after. Referral for cancer prevention measures was assessed at a median of 8 (2-12) months after CRC diagnosis in groups A and B before the dissemination of the strategy and in group A after. In group B referral was assessed at a median of 9 (4-11) months after the dissemination of the strategy. Uptake of genetic counselling by high risk patients was equal in groups A and B, being 33% before and 15% after (P = 0.003). Uptake of surveillance colonoscopy by moderate risk relatives did not change significantly (group A, 36% before vs 41% after; group B, 33% before vs 19% after). In group B 94/140 patients (67%) and 25/72 clinicians (35%) visited the website and 34/140 (24%) patients read the brochure. Patients valued clinicians' information as most useful, followed by the patient brochure. Clinicians preferred pocket cards and education. CONCLUSION: Our strategy did not improve referral for cancer prevention measures. Although the newly offered strategy elements were appreciated, patients preferred clinicians' advice regarding referral for cancer prevention measures. It may be useful to aim future interventions at healthcare professionals rather than patients to improve the prevention of familial cancer.
Databáze: OpenAIRE
Externí odkaz: