Enabling family communication about cancer - Do you know your Kin Facts?

促进家庭关于癌症的沟通 - 您知道您的亲属事实吗？

• 批准号: 8432548
• 负责人: John M. Quillin
• 金额: $ 0.75万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8432548
• 关键词: Address; Adult; Advanced Malignant Neoplasm; Advisory Committees; African American; Baseline Surveys; Behavior; Biological; Breast; Breast Cancer Risk Assessment Tool; Cancer Control; Cancer Family; Cancer-Predisposing Gene; Caucasians; Caucasoid Race; Chemoprevention; Clinic; Clinic Visits; Clinical; Collection; Colon Carcinoma; Colonoscopy; Communication; Communication Research; Control Groups; Data; Data Analyses; Death Rate; Detection; Diagnosis; Disease; Disease Outcome; Education; Ensure; Environment; Ethnic Origin; Family; Family health status; Family history of; Family member; Fecal occult blood; Future; Gene Mutation; Genealogical Tree; Genetic; Genetic Screening; Genomics; Goals; Gynecology; Health; Health Personnel; Health behavior; Hereditary Breast Carcinoma; Hereditary Malignant Neoplasm; Individual; Intervention; Interview; Knowledge; Literature; Low income; Malignant Neoplasms; Mammography; Measurement; Mediating; Mediator of activation protein; Medical; Methods; Modeling; Modern Medicine; Molecular; Molecular Genetics; Outcome; Participant; Patients; Prevention; Prevention Research; Preventive; Primary Health Care; Professional counselor; Public Health; Race; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Reproductive History; Research; Resources; Risk; Risk Assessment; Risk Estimate; Risk Reduction Behavior; Sampling; Screening procedure; Secondary Prevention; Self Efficacy; Services; Sigmoidoscopy; Statistical Models; Structure; Technology; Telephone; Testing; Time; Translations; United States; Universities; Virginia; Visit; Woman; Women' s Group; Women' s Health; Work; Writing; arm; base; cancer genetics; cancer health disparity; cancer prevention; cancer risk; clinical care; clinical practice; disorder risk; empowered; follow-up; genetic risk assessment; group intervention; improved; intervention effect; lifetime risk; malignant breast neoplasm; primary outcome; programs; psychosocial; public health relevance; randomized trial; safety net; skills; standard care; tool

DESCRIPTION (provided by applicant): Despite medical and technological advances, cancer health disparities continue to occur in prevention, diagnosis, and outcomes. Family health history (FH) is among the strongest known predictors of cancer (CA) and is the most powerful, publicly accessible screen for genetic CA risk. To fill the gap in practical interventions for necessary family communication, we propose to develop and evaluate a clinically integrated intervention to improve patient-family communication about CA risk and prevention. Using the Kin Fact Program (Keeping Information about Family Cancer Tune-up Program), a research assistant (RA) will work 1-on-1 with 245 adult women, recruited over the course of 2 years from annual gynecology visits at the VCU Women's Health Clinic within a randomized trial. The RA will help participants draw a family tree, identify biological kin, and document information about biological family who have had breast cancer (BC) or colon cancer (CC). In this 20-30 minute session, the assistant will: (a) provide risk information and appropriate health recommendations; (b) identify family information needed to complete the FH; (c) coach woman in communication skills to obtain information, and (d) develop, with her, a plan for collection and follow-up on this data gathering. Another 245 women randomized to the control arm will receive standard care. We will test for differences between the intervention and control groups on the primary outcome of family communication about CA. We will also assess the intervention impact on CA-related genetic knowledge and risk-reduction behaviors at 1, 6, and 14 months after the intervention, using written baseline surveys and structured follow-up phone interviews. About 45% of the VCU Women's Health Clinic patients are African-American and about 1/3 are under-insured. By integrating the model within an urban women's health safety-net clinic, this project addresses cancer control and prevention research challenges of racial diversity, inclusive practices, and clinical translation. Our long-term objectives are to: improve public health, specifically related to BC and CC, by maximizing genetic risk assessment through FH collection and communication, eliminate disparities in who benefits from familial risk information, and identify successful methods for enabling women to be effective FH and cancer prevention communicators. Specific aims: 1. Assess the effect of the Kin Fact program on communication about FH of BCs and CCs. We will investigate race/ethnicity and education as effect modifiers. 2. Assess change differences (intervention vs. control) in reported family communication contexts and their mediator effects on communication outcomes. 3. Assess change differences (intervention vs. control) in critical knowledge about CA-related genetic information (knowledge of the genetic component to cancer, in general and also their specific individual risks and capacity to identify resources). 4. As a secondary aim we will examine health behavior differences (intervention vs. control) (e.g. clinical breast exams, mammograms, colonoscopy, USPSTF practices, etc.) for the subset of participants to whom these screening behaviors apply. PUBLIC HEALTH RELEVANCE: Twenty-first century public health approaches to cancer prevention and control need to incorporate genetic information, family health history being the most accessible. The higher death rates from all cancers in African Americans compared to Caucasians demand efforts to explore disparities in family understanding of cancer risk. It is critical to understand ways to improve communication about cancer risk and prevention among family members through accessible interventions in women's primary care, and to ensure the interventions are equitably effective.

描述（由申请人提供）：尽管医学和技术取得了进步，但在预防、诊断和结果方面仍然存在癌症健康差异。家族健康史 (FH) 是已知最强的癌症 (CA) 预测因素之一，也是最强大、可公开获取的遗传性 CA 风险筛查。为了填补必要的家庭沟通实际干预措施的空白，我们建议开发和评估临床综合干预措施，以改善患者与家庭关于 CA 风险和预防的沟通。利用 Kin Fact 计划（保留有关家庭癌症调整计划的信息），一名研究助理 (RA) 将与 245 名成年女性进行一对一的工作，这些女性是在 2 年内从 VCU 妇女医院每年妇科就诊中招募的随机试验中的健康诊所。 RA 将帮助参与者绘制家谱、识别生物学亲属并记录有关患有乳腺癌 (BC) 或结肠癌 (CC) 的生物学家族的信息。在这个 20-30 分钟的会议中，助理将： (a) 提供风险信息和适当的健康建议； (b) 确定完成 FH 所需的家庭信息； (c) 指导妇女获取信息的沟通技巧，以及 (d) 与她一起制定收集数据并采取后续行动的计划。另外 245 名随机分配到对照组的女性将接受标准护理。我们将测试干预组和对照组之间关于 CA 的家庭沟通主要结果的差异。我们还将使用书面基线调查和结构化后续电话访谈，评估干预后 1、6 和 14 个月对 CA 相关遗传知识和风险降低行为的影响。 VCU 女性健康诊所约 45% 的患者是非裔美国人，约 1/3 的保险不足。通过将该模型整合到城市妇女健康安全网诊所中，该项目解决了种族多样性、包容性实践和临床转化方面的癌症控制和预防研究挑战。我们的长期目标是：通过 FH 收集和交流最大限度地提高遗传风险评估，改善公共卫生，特别是与 BC 和 CC 相关的公共卫生，消除谁从家庭风险信息中受益的差异，并确定使女性能够发挥作用的成功方法FH 和癌症预防传播者。具体目标： 1. 评估 Kin Fact 计划对 BC 和 CC 的 FH 沟通的影响。我们将调查种族/民族和教育作为影响因素。 2. 评估报告的家庭沟通环境中的变化差异（干预与控制）及其对沟通结果的中介效应。 3. 评估有关 CA 相关遗传信息的关键知识（癌症遗传成分的一般知识以及其特定的个体风险和识别资源的能力）的变化差异（干预与控制）。 4. 作为次要目标，我们将检查适用这些筛查行为的参与者子集的健康行为差异（干预与控制）（例如临床乳房检查、乳房 X 光检查、结肠镜检查、USPSTF 实践等）。 公共卫生相关性：二十一世纪预防和控制癌症的公共卫生方法需要纳入遗传信息，而家族健康史是最容易获得的。与白人相比，非裔美国人所有癌症的死亡率较高，因此需要努力探索家庭对癌症风险了解的差异。了解如何通过妇女初级保健的便利干预措施来改善家庭成员之间关于癌症风险和预防的沟通，并确保干预措施的公平有效，这一点至关重要。