Improving Knowledge of Familial Colorectal Cancer Risk Using the ACG Brochure

Abstract

Purpose: Previously we have shown that only 49% of patients with a history of colorectal cancer (CRC) understood their family members' increased risk of CRC, and a significant number of these did not know appropriate screening recommendations. In addition, there was a significant disparity between Caucasian and African American patients' knowledge (DDW 2005). This is a follow-up of our first study, and was performed to test the impact of an educational brochure on the understanding of familial risk and screening recommendations. Methods: In phase 1 of this study, a 12 question telephone survey was administered to 254 CRC patients in the University of Chicago Cancer Registry. They were subsequently mailed a brochure developed by the American College of Gastroenterology, “Understanding Colorectal Cancer Screening: A Consumer Education Brochure.” In phase 2 of the study, these patients were re-surveyed 6 months later with the same instrument to test the ability of the brochure to improve understanding of family risk and current screening guidelines. Univariate and multivariate logistic regression was performed. Results: 202 patients (80%) participated in phase 2 of the study. Inter-phase reliability was excellent (r = 0.95). The perceived CRC risk for FDRs did not change in phase 2 (Wilcoxon rank test, p = 0.22), but knowledge of the correct age of CRC screening (within 5 y) improved after the intervention (43% v 56%, p = 0.007). The proportion of participants who told family they were at elevated risk increased, but the change was not significant. (p = .0.06), but the proportion of participants who told family members about CRC screening increased significantly (p < 0.001). In both univariate analysis and multivariate logistic regression, Caucasians and participants with a younger age at CRC diagnosis were associated with increased familial risk understanding in phase 1 and 2. In addition, age at diagnosis and higher educational attainment were associated with better knowledge of correct screening age for CRC in phase 2. Conclusions: The ACG CRC Brochure is effective at improving knowledge of age of screening and asking family to be screened, but is not effective at improving general knowledge about familial risk of CRC, and did not improve racial or educational disparities. More effective targeted interventions are needed to address the significant lack of understanding of familial CRC risk.