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）：尽管医疗和技术进步，但预防，诊断和结果仍会发生癌症健康差异。家庭健康史（FH）是癌症（CA）的最强预测因素之一，是遗传CA风险最强大，最容易获得的屏幕。为了填补实际干预措施的差距以进行必要的家庭沟通，我们建议开发和评估临床整合的干预措施，以改善与患者有关CA风险和预防的与患者的沟通。使用KIN FACT计划（保留有关家庭癌症调节计划的信息），研究助理（RA）将与245名成年妇女进行1对1的工作，并在随机试验中在VCU妇女健康诊所的年度妇科访问中招募了2年。 RA将帮助参与者绘制一棵家谱，识别生物亲戚，并提供有关患有乳腺癌（BC）或结肠癌（CC）的生物家庭的文档信息。在这个20-30分钟的会议中，助手将：（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）沟通技巧的教练妇女以获取信息，（d）与她一起制定收集和跟进该数据收集的计划。随机将245名妇女随机分配到控制臂将获得标准护理。我们将测试干预组和对照组之间关于家庭交流的主要结果的差异。我们还将使用书面基线调查和结构化的后续电话访谈评估对CA相关的遗传知识和减少风险降低行为的干预影响。 VCU妇女健康诊所患者中约有45％是非裔美国人，大约1/3的保险不足。通过将模型整合到城市妇女的健康安全网诊所中，该项目应对癌症控制和预防研究的挑战，对种族多样性，包容性实践和临床翻译的挑战。我们的长期目标是：通过通过收集和交流来最大化遗传风险评估，消除对家庭风险信息受益的人的差异，并确定使妇女能够有效的FH和预防癌症预防者的成功方法，从而改善公共卫生，特别是与BC和CC相关的公共卫生。具体目的：1。评估亲属事实计划对BCS和CCS FH沟通的影响。我们将研究种族/种族和教育作为效果修饰符。 2。评估报告的家庭交流环境中的变化差异（干预与控制）及其对沟通结果的介体影响。 3.评估有关CA相关遗传信息的批判性知识（一般而言，总体上对癌症的遗传成分的知识，以及其特定的个人风险和识别资源的能力）评估变化差异（干预与控制）。 4。作为次要目的，我们将检查健康行为差异（干预与控制）（例如临床乳房检查，乳房X线照片，结肠镜检查，USPSTF实践等），以适用于这些筛查行为的参与者子集。 公共卫生相关性：二十一世纪的公共卫生预防和控制方法需要纳入遗传信息，家庭健康史最容易获得。与高加索人相比，非裔美国人所有癌症的死亡率较高，要求努力探索家庭对癌症风险的差异。了解通过在妇女的初级保健中进行的干预措施来改善家庭成员之间对癌症风险和预防的沟通的方法至关重要，并确保干预措施公平地有效。