Understanding family history and risk communication among advanced colorectal polyp patients and their close relatives
Date
2023
DOI
Authors
Deplas, Peter Alexander
Version
OA Version
Citation
Abstract
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-associated mortality in the United States, with a cumulative lifetime risk of approximately 4% to 5% among women and men respectively. CRC incidence and mortality can be reduced through the detection and removal of precancerous polyps. Patients with first degree relatives (FDRs) diagnosed with advanced adenomas or CRC are at increased risk for CRC and advanced colorectal polyps compared to those without a family history. National guidelines put forth by the United States Preventive Services Task Force (USPSTF) recommend that people at average risk should start screening for colorectal cancer at the age of 45. Adherence to national guidelines among high and average-risk individuals is less than 20%. Favorable screening behavior and adherence to guidelines has been associated with knowledge of one’s family history of colorectal neoplasia or CRC. Much of the previous research in this area has been on families with known genetic risk for developing CRC. This includes inherited conditions such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC/Lynch Syndrome). For those without a genetic predisposition, there is little research on screening adherence for FDRs of CRC patients. Furthermore, there is even less research on guideline adherence for FDRs of advanced polyp patients.
OBJECTIVE: The primary aim of this qualitative research study is to assess post-colonoscopy communication among patients and providers regarding the national guidelines for earlier screening for first degree relatives of advanced colorectal polyp patients and identify barriers to discussing family history and colonoscopy results among patients and their FDRs. Secondary aims of this study are 1) Evaluate patient understanding of their personal colorectal risk status 2) Determine what support/resources colonoscopy patients would need in order to speak with their FDRs about getting screened. 3) Evaluate patient interest in receiving a CRC risk comprehension tool in the form of a brochure or text messaging service.
METHODS: This study conducted 15-minute long phone interviews with patients who met the criteria for the study. Interviews were used to further explore barriers and facilitators to familial risk communication. Participants were asked to
describe their family experience with CRC and colonoscopy diagnoses and their family communication strategies.
RESULTS: The results indicated that barriers of communication with FDRs were present across all participants (n=4). Lack of colonoscopy understanding and its implications towards FDR’s risk (n=1), difficulty speaking to FDR due to personal matters (n=2), and fear of placing burden on FDRs (n=1) were among the main barriers.
CONCLUSION: We found that patients' relationships with their FDRs to be most significant in communication of risk and adherence to screening guidelines. Furthermore, a brochure as well as a texting service were found to be possible solutions in increasing awareness for patient’s colonoscopy findings.