Identifying cluster subtypes for intentions to have colorectal cancer screening among non-compliant intermediate-risk siblings of individuals with colorectal cancer

Predictors of colorectal cancer screening intention based on the integrated theory of planned behavior among the average-risk individuals

Background

This study aimed to determine the predictors of colorectal cancer screening intention based on the integrated theory of planned behavior among average -risk individuals in Urmia. Identifying these predictors will help design and implement various interventions, including educational interventions, according to the needs of this group, thereby taking a step towards improving the colorectal cancer screening index.

Methods

The present cross-sectional study was performed on 410 individuals at average risk of colorectal cancer referring to the comprehensive health services centers of Urmia in Iran. The data collection tool was a researcher-made questionnaire consisting of two parts. The first part captured the demographic information and medical history of the participants. The second part involved questions designed based on constructs of motivational phase of health action process approach, and theory of planned behavior, as well as behavioral intent to perform colorectal cancer screening. Data analysis was performed using SPSS software.

Results

Outcome expectancies, risk perception, action self-efficacy, and normative beliefs, respectively had the largest impact and were significant and positive predictors of colorectal cancer screening intention. The study’s conceptual framework explained about 36% of the variance of behavioral intention among the average-risk individuals in Urmia.

Conclusions

Constructs of motivational phase of health action process approach, and theory of planned behavior are valuable and appropriate to identify the factors affecting the intention to undergo colorectal cancer screening as well as to design and implement educational interventions in this field. The four constructs of outcome expectancies, risk perception, action self-efficacy, and normative beliefs are suggested to be integrated into all educational interventions designed and implemented to improve the colorectal cancer screening index.

The effect of educational intervention based on theory of planned behavior on the improvement of colorectal cancer screening intention among average-risk individuals referring to Asadabad city clinics

BACKGROUND

Colorectal cancer (CRC) is the third most common cancer in men and the fourth most common cancer in women in Iran. Therefore, the aim of this study was to determine the effect of educational intervention based on the theory of planned behavior (TPB) on the improvement of CRC screening intention among average-risk individuals.

MATERIALS AND METHODS

This quasi-experimental study was performed on the 50-69-year-old individuals referred to Asadabad city clinics in 2020. The individuals were randomly assigned to multistage cluster sampling in each intervention and control group. The instrument used in this research was a researcher-made questionnaire based on TPB. Educational intervention was conducted for the intervention group, one of their family members, and staff of clinic under intervention. Finally, the data were entered into SPSS and analyzed utilizing descriptive and analytical statistics. Results were considered significantly <0.05.

RESULTS

There were no significant differences between two intervention and control groups in the preintervention phase in terms of the mean scores of attitude (P = 0.58), subjective norms (P = 0.59), and behavioral intention (P = 0.66). However, in the postintervention phase, these differences were significant. Furthermore, regarding the mean score of perceived behavioral control, there was a significant difference between the two groups in the preintervention phase (P < 0.02), while in the postintervention phase, this difference was not significant (P = 0.29).

CONCLUSION

Educational intervention based on the TPB has been effective in improving the CRC screening intention among average-risk individuals. Therefore, using the results of this research and developing appropriate educational programs at the community level can be increased the participation of community members in CRC screening programs.

Operationalization of skin self-examination in randomized controlled trials with individuals at increased risk for melanoma: A systematic review

OBJECTIVE

To investigate how skin self-examination was operationalized and the psychometric properties of the scales used to assess this behavior in randomized controlled trials (RCTs) testing interventions that promote SSE among individuals at increased risk for melanoma.

METHOD

Eight scientific databases (e.g., Medline, EMBASE, CINAHL, PsycINFO) and four trial registries (e.g., Clinicaltrials.gov, UK Clinical Trails Gateway) were searched from inception through April 2, 2019. Three reviewers carried out the selection of relevant trials and conducted data extraction.

RESULTS

The review identified 13 unique RCT's. The definition of skin self-exams, extrapolated from instructions provided to participants during the trials and reported in only 6/13 trials, included periodically checking the skin of the entire body, individually or with partners/mirrors, with or without tracking or monitoring tools, and using the ABCDE criteria to identify early signs of melanoma. There was variability in how skin self-examination behavior was measured with respect to item content, number of items, response format, and type of outcome variable used: continuous or binary). No validity evidence and minimal reliability evidence for the measures were identified.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Future studies are needed to establish the psychometric properties of measures assessing skin self-examination.

Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state-of-the-science review

Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first-degree relative (FDR) increases the CRC risk 2-fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider-patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high-risk groups. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2633-2645. © 2016 American Cancer Society.

A population-based cross-sectional study of colorectal cancer screening practices of first-degree relatives of colorectal cancer patients

Background

The aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs) of colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance with CRC screening guidelines.

Methods

Colorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer Registry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs were deemed asymptomatic and eligible for analysis.

Results

Sixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those with private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor were significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of FDRs “at or slightly above average risk” were adherent to CRC screening guidelines. For this group, adherence to guideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher level of education. For persons at “moderately increased risk” and “potentially high risk”, 47% and 49% respectively adhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more likely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever asked about family history of CRC.

Conclusions

A significant level of non-compliance with screening guidelines was evident among FDRs. Improved CRC screening in accordance with guidelines and effective systematic interventions to increase screening rates among population groups experiencing inequality are needed.

Trial Registration

Australian and New Zealand Clinical Trial Registry: ACTRN12609000628246

Cancer prevention and screening practices of siblings of childhood cancer survivors: a report from the Childhood Cancer Survivor Study

BACKGROUND

To compare the skin and breast/cervical cancer prevention/screening practices of adult siblings of childhood cancer survivors with controls and to identify modifying factors for these practices.

METHODS

Cross-sectional, self-report data from 2,588 adult siblings of 5+ year survivors of childhood cancer were analyzed to assess cancer prevention/screening practices. Two age, sex, and race/ethnicity-matched samples (N = 5,915 and N = 37,789) of the Behavioral Risk Factor Surveillance System participants served as the comparison populations. Sociodemographic and cancer-related data were explored as modifying factors for sibling cancer prevention/screening practices through multivariable logistic regression.

RESULTS

Compared with controls, siblings were more likely to practice skin cancer prevention behaviors: use of protective clothing [OR, 2.85; 95% confidence interval (CI), 2.39-3.39], use of shade (OR, 2.11; 95% CI, 1.88-2.36), use of sunscreen (OR, 1.27; 95% CI, 1.14-1.40), and wearing a hat (OR, 1.77; 95% CI, 1.58-1.98). No differences were noted for breast/cervical cancer screening including mammography and Pap testing. Having less than a high school education and lack of health insurance were associated with diminished cancer prevention/screening behaviors. Survivor diagnosis, treatment intensity, adverse health, chronic health conditions, and second cancers were not associated with sibling cancer prevention/screening behaviors.

CONCLUSIONS

Siblings of cancer survivors report greater skin cancer prevention practices when compared with controls; however, no differences were noted for breast/cervical cancer screening practices. Access to care and lack of education may be associated with decreased cancer prevention/screening behaviors. Interventions are needed to address these barriers.

IMPACT

Research should be directed at understanding the impact of the cancer experience on sibling health behaviors.

Tailored versus generic interventions for skin cancer risk reduction for family members of melanoma patients

BACKGROUND

Improving strategies for risk reduction among family members of patients with melanoma may reduce their risk for melanoma.

OBJECTIVE

To evaluate the effects of two behavioral interventions designed to improve the frequency of total cutaneous skin examination by a health provider (TCE), skin self-examination (SSE), and sun protection among first degree relatives of patients with melanoma; and to evaluate whether increased intentions, increased benefits, decreased barriers, and improved sunscreen self-efficacy mediated the effects of the tailored intervention, as compared with the generic intervention on TCE, SSE, or sun protection.

METHODS

Four hundred forty-three family members (56 parents, 248 siblings, 239 children) who were nonadherent with these practices were randomly assigned to either a generic (N = 218) or a tailored intervention (N = 225) which included 3 print mailings and 1 telephone session. Participants completed measures of TCE, SSE, and sun protections at baseline, 6 months, and 1 year, and measures of intentions, benefits, barriers, and self-efficacy at baseline and 6 months.

RESULTS

Those enrolled in the tailored intervention had almost a twofold increased probability of having a TCE ( p < .0001). Treatment effects in favor of the tailored intervention were also noted for sun protection habits ( p < .02). Increases in TCE intentions mediated the tailored intervention's effects on TCE. Increases in sun protection intentions mediated effects of the tailored intervention's effect on sun protection.

CONCLUSIONS

Tailored interventions may improve risk reduction practices among family members of patients with melanoma.