Abstract
BackgroundTargeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network.MethodsA cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect.Results172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6).ConclusionsThe factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives.
Highlights
Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low
Few studies on the factors associated with participation in colorectal cancer (CRC) screening by firstdegree relatives (FDRs), recruited subjects at increased risk as defined by the recommendations currently in force [13]
Siblings were excluded from the study if they fell outside the criteria for screening as defined by the recommendations: personal history of CRC or chronic inflammatory bowel disease, colonoscopy performed in the context of symptoms, falling outside the age range intended by the French recommendations
Summary
Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The Health Belief Model (HBM) [15] has proved its relevance in the study of individual preventive health behaviour, especially in colorectal cancer [6,7,8,9,11] and interviews [14] brought out the four major constructs of the HBM - perceived susceptibility to and severity of CRC, perceived benefits of and barriers to participating in screening - and referred to motivation to safeguard health [16,17] These interviews pointed out a normative dimension (how much the person feels social pressure to do something), which is a component of the Theory of Reasoned Action (TRA), another psychosocial model of preventive behaviour [18] which, to our knowledge, has not been studied in the context of targeted screening. This model provides the structural (quantitative aspects such as number of ties and frequency of contact with ties) and functional aspects, including emotional support (receiving reassurance that one is loved and cared for) and material support (assistance provided by social network ties) [19]
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