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

Dekker N1, Hermens RP, de Wilt JH, van Zelst-Stams WA, Hoogerbrugge N; The RISCO study group.

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Abstract

AIM:

Only 12-49% of CRC patients and their first-degree relatives with an increased familial colorectal cancer (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 randomised 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 the 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 group 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 versus 41% after; group B: 33% before versus 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 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. This article is protected by copyright. All rights reserved.