PROJECT SUMMARY ABSTRACT
The rate of adherence to regular colonoscopy screening among members of families at increased risk for
colorectal cancer (CRC) is far below recommended levels. Persons who live in rural areas of the United States
exhibit lower colorectal screening rates than their urban counterparts. Although the detection of familial
predisposition to cancer begins with an accurate family medical history, data indicate that many patients do not
receive adequate familial cancer risk assessment from their primary care providers. This suggests that familial
risk is largely unrecognized which may lead to inadequate risk stratification, lack of risk notification, appropriate
risk counseling, suboptimal cancer screening and preventable deaths. Because of geographic and system-
level barriers, special efforts are needed to improve access to personalized risk communication and adherence
to CRC screening in rural dwellers at increased risk for CRC. In the proposed study, we will evaluate a novel
telephone-based, theory-guided personalized risk communication intervention that combines a familial CRC
risk assessment and behavioral counseling with tailored messages. The key hypothesis guiding this study is
that a more intensive personalized risk communication intervention will improve CS at a significantly higher
rate than a low-intensity targeted print intervention. Our integrative study model specifies important theoretical
mechanisms that can contribute to increased use of CS among persons at increased risk. We will enroll 712
rural adult men and women age 40 years and older who are considered at increased risk of familial CRC into
this 2-group randomized trial. The primary aim of this study is to compare colonoscopy use among participants
in the two groups. Secondary aims are to compare the two groups with regard to cognitive and emotional
outcomes and explore the underlying mechanisms through which the interventions have an impact on
colonoscopy behavior. Sociodemographic, clinical, behavioral and psychosocial measures will be collected
from participants at baseline, 1 month, 6 months and 1 year. The study's findings will have both theoretical, as
well as practical, significance. Our findings will help to influence the selection and dissemination of effective
outreach approaches to improve CRC screening in populations at increased risk for the disease. These results
have broad applicability to understanding responses to personalized risk communication interventions for other
diseases as well. Findings will also broaden our understanding of the underlying theoretical mechanisms of
how remote cancer risk communications lead to improvements in cancer screening among geographically
underserved populations if such intervention effects are observed
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