Comparative Effectiveness of Two Interventions to Increase Colorectal Cancer Screening for those at Increased Risk Based on Family History: Results of a Randomized Trial

BACKGROUND:

First degree relatives (FDRs) of colorectal cancer (CRC) patients are at risk for CRC, but may not be up to date with CRC screening. We sought to determine if a one-time recommendation about needing CRC screening using patient navigation (PN) was better than just receiving the recommendation only.

METHODS:

Participants were FDRs of Lynch syndrome negative CRC patients from participating Ohio hospitals. FDRs from 259 families were randomized to a website intervention (528 individuals), which included a survey and personal CRC screening recommendation, while those from 254 families were randomized to the website plus telephonic PN intervention (515 individuals). Primary outcome was adherence to the personal screening recommendation (to get screened or not to get screened) received from the website. Secondary outcomes examined who benefited from adding PN.

RESULTS:

At the end of the 14-month follow-up, 78.6% of participants were adherent to their recommendation for CRC screening with adherence similar between arms (p=0.14). Among those who received a recommendation to have a colonoscopy immediately, the website plus PN intervention significantly increased the odds of receiving screening, compared to the website intervention (OR: 2.98, 95% CI: (1.68, 5.28).

CONCLUSIONS:

Addition of PN to a website intervention did not improve adherence to a CRC screening recommendation overall, however, the addition of PN was more effective in increasing adherence among FDRs who needed screening immediately.

IMPACT:

These findings provide important information as to when the additional costs of PN are needed to assure CRC screeningamong those at high risk for CRC.