Telehealth Personalized Cancer Risk Communication to Motivate Colonoscopy in Relatives of Patients With Colorectal Cancer: The Family CARE Randomized Controlled Trial

Abstract

A B S T R A C T PurposeThe rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer (CRC) is suboptimal, especially among rural and other geographically underserved populations. Remote interventions may overcome geographic and system-level barriers. We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC. MethodsEligible individuals age 30 to 74 years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states. Enrollees were randomly assigned as family units to either an active, personalized intervention that incorporated evidence-based risk communication and behavior change techniques, or a mailed educational brochure. The primary outcome was medically verified colonoscopy within 9 months of the intervention. ResultsOf the 481 eligible and randomly assigned at-risk relatives, 79.8% completed the outcome assessments within 9 months; 35.4% of those in the personalized intervention group and 15.7% of those in the comparison group obtained a colonoscopy. In an intent-to-treat analysis, the telehealth group was almost three times as likely to get screened as the low-intensity comparison group (odds ratio, 2.83; 95% CI, 1.87 to 4.28; P Ͻ .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents. ConclusionRemote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.

Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review (Preprint)

“…In 21 out of 24 studies the patient-caregiver dyad was analysed, interventions were delivered to both patients and caregivers and outcomes measured in both populations. In three studies caregivers were the only target sample and patients variables' were not considered [49][50][51]. Three studies focused the intervention only on women, two of them were for partners [52,53] and one included carers with different relationships to patients [54].…”

“…Eight of them were conducted by prepared nurses [48,52,54,56,59,61,62,71]; four were carried out by social workers [60,65,68,70]; three were operated at a distance by carers distance using web-based platforms [51,55,58]. In three randomized trials the intervention was delivered by clinical psychologists [53,62,69], while in another trial a genetic counsellor conducted the telehealth risk communication to motivate colonoscopy [49]. Two studies provided psychosocial support via a multidisciplinary team including a chaplain, counsellor, dietician, physiotherapist, and physician [63], or a clinical psychologist, psychiatrist, advanced practice nurse, hospital chaplain, clinical social worker, physiatrist, and physical therapist [64].…”

“…In fact, Kinney et al (2014) [49] studied only the adoption of colonoscopy prevention behaviour, whereas Clark et al (2013) [64] assessed Quality of Life adjustment of advanced cancer patients under radiotherapy treatment (see Table 1). …”

“…In twelve papers an intervention was developed an intervention for a unique type of cancer patients [49,[51][52][53][54]58,60,61,65,66,68,70], while the others implemented telemedicine tools for a multifaceted sample including patients with different cancer diagnoses [48,50,[55][56][57]59,[62][63][64]67,71].…”

“…Master-prepared nurses, clinical social workers and psychologists were trained, and sometimes allocated in multidisciplinary teams, to help caregivers in their process of patient care. All participants either of the experimental and the control group received telehealth intervention, except for seven studies where the control group received only the usual care [49,52,54,59,62,64,66].…”