Telehealth personalized cancer risk communication to motivate colonoscopy in relatives of patients with colorectal cancer: the family CARE Randomized controlled trial

Abstract

Purpose: The 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.

Methods: Eligible 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.

Results: Of 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 < .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents.

Conclusion: Remote 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.

Fig 1.

Graphical depiction of the high- and low-intensity interventions. (a) Survey to determine self-reported baseline clinical information, including colonoscopy screening, family history of cancer, sociodemographics, and psychosocial data; (b) mailed educational brochure targeted to participants' risk status; (c) mailed tailored visual aids; (d) tailored telephone cancer risk assessment and counseling session; (e) mailed tailored summary letter of TeleCARE (Tele–Cancer Risk Assessment and Evaluation) session; (f) mailed tailored reminder card.

Fig 2.

Diagram showing screening, random assignment, and follow-up of the study participants. (*) Based on work by Tan et al. (†) Participants who did not complete a survey were asked to complete a very brief survey containing primary outcome questions only. (‡) Medical-record verified (MRV). (§) Included in imputation analysis. TeleCARE, Tele–Cancer Risk Assessment and Evaluation.

Fig 3.

Investigation of effect modification of subgroups on the odds of colonoscopy uptake and 95% CI. TeleCARE, Tele–Cancer Risk Assessment and Evaluation.