Abstract
BackgroundFamily history is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers' current practice relating to: (i) assessment of family history of CRC; (ii) notification of "increased risk" to patients at "moderately/potentially high" familial risk; and (iii) recommendation that patients undertake CRC screening.Methods1592 persons aged 56-88 years randomly selected from the Hunter Community Study (HCS), New South Wales, Australia were mailed a questionnaire. 1117 participants (70%) returned a questionnaire.ResultsThirty eight percent of respondents reported ever being asked about their family history of CRC. Ever discussing family history of CRC with a health care provider was significantly more likely to occur for persons with a higher level of education, who had ever received screening advice and with a lower physical component summary score. Fifty one percent of persons at "moderately/potentially high risk" were notified of their "increased risk" of developing CRC. Thirty one percent of persons across each level of risk had ever received CRC screening advice from a health care provider. Screening advice provision was significantly more likely to occur for persons who had ever discussed their family history of CRC with a health care provider and who were at "moderately/potentially high risk".ConclusionsEffective interventions that integrate both the assessment and notification of familial risk of CRC to the wider population are needed. Systematic and cost-effective mechanisms that facilitate family history collection, risk assessment and provision of screening advice within the primary health care setting are required.
Highlights
History is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation
To our knowledge the current study presents as the first community-based evaluation of health care providers practice relating to CRC family history assessment and notification of “increased risk” to persons at elevated levels of familial risk ("moderately increased/ potentially high risk”)
Respondents previously diagnosed with CRC (n = 24) or reporting they had undergone major abdominal surgery (n = 8) were excluded from analysis, leaving a total sample of 1085 eligible participants with data
Summary
History is a common risk factor for colorectal cancer (CRC), yet it is often underused to guide risk assessment and the provision of risk-appropriate CRC screening recommendation. The aim of this study was to identify from a patient perspective health care providers’ current practice relating to: (i) assessment of family history of CRC; (ii) notification of “increased risk” to patients at “moderately/potentially high” familial risk; and (iii) recommendation that patients undertake CRC screening. This study indicated a one-third reduction of incidence and 40% reduction in mortality for persons undertaking sigmoidoscopy screening [11]. Colonoscopy remains untested in randomised trials, case control and cohort studies using large-bowel endoscopy have shown a CRC mortality reduction rate ranging from 60% to 76% [12] and incidence reduction of 76% to 90% [5]. Relatively little is known about current practice relating to health care providers’ identification and notification of persons at elevated-risk of CRC. The few studies [18,23,27,28] which have assessed this issue have been conducted within North American family practice settings adopting patient record audit
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