A Program for Improved Family Screening for Colorectal Cancer
A Program for Improved Family Screening for Colorectal Cancer
A first- degree family history of colorectal cancer (CRC) or adenoma before age 65 is
 associated with a high risk of CRC. For these high-risk subjects, the French 2013
 recommendations advise colonoscopy screening, but participation is insufficient (26-54%).The
 purpose of this project is to propose, through association of multidisciplinary research
 teams (public health, sociology, linguistic), actors on the field (physicians, organized
 screening facilities), and decision makers, relevant and effective interventions in the
 framework of a public health program, enabling increased participation of relatives of
 patients with CRC or adenoma before age 65 in targeted screening for CRC by colonoscopy.
A first-degree family history of colorectal cancer (CRC) or adenoma before age 65 is
 associated with a high risk of CRC. For these high-risk subjects, the French 2013
 recommendations advise colonoscopy screening, but participation is insufficient (26-54%).The
 purpose of this project is to propose, through association of multidisciplinary research
 teams (public health, sociology, linguistic), actors on the field (physicians, organized
 screening facilities), and decision makers, relevant and effective interventions in the
 framework of a public health program, enabling increased participation of relatives of
 patients with CRC or adenoma before age 65 in targeted screening for CRC by colonoscopy.

 Description of the intervention: This program, offered in 4 departments is divided into 3
 phases:

 1. Sensitization of doctors to the recommendations. This is a collaborative work with
 clinicians to enable them i) to take ownership of the problem and generic documents used
 in the previous study and ii) to define an intervention logic to encourage them to
 systematically inform subjects with RCC or advanced adenoma before age 65 the increased
 risk related to their 1st degree.

 2. Coordinated transmission of information from the patient's physician to the relative's
 physician under consent of the patient and his/her relatives. Under the terms
 established with the actors in the previous phase, the physician delivers standard
 information to the index patient, presents the generic documents and may adapt the
 procedure to each patient's needs. With support of the coordination team which collects
 the coordinates of 1st degree relatives, the patient's physician transmits the
 information to the relatives and their doctors. The coordination team, during this
 experimental phase, will be the team of Epidemiology, Cancer Registry of Poitiers
 University Hospital, under the responsibility of public health physicians. The
 coordination team contacts each relative on behalf of the index patient's consent,
 acting by delegation of the index patient's physician, informs about the transmission of
 information given to the index patient, requests the agreement of the relative that the
 patient's doctor would contact his/her doctor to inform, under cover of professional
 secrecy, of the medical context.

 3. Personalized information of relatives by a preventive nurse based on validated
 prevention models (individual psychosocial factors associated with screening and
 behavioral stage). At most two years after diagnosis of the index patient, the
 relative's colonoscopy performance status will be ascertained by the coordination team
 in connection with the attending physician. If the relative has had a colonoscopy
 carried out, the coordination team shall document the results and note the date
 scheduled for the following exam. If the relative has not had a colonoscopy carried out,
 he shall then receive a personalized intervention, based on the intervention evaluated
 in the previous study, as a supplement to the action of his/her doctor.

 Qualitative and quantitative evaluations will follow each phase to measure the acceptability,
 coverage, efficiency, to assess transferability of the program. Moreover the program will be
 evaluated by a population survey conducted by the cancer registry that covers the
 geographical area of the experimentation with data collection that identify exhaustively the
 patients with CRC or high-grade adenoma.
Inclusion Criteria:

 -  First-degree relatives of an index patient: father, mother, children, brothers and
 sisters (aged more than 18 years).

 Informed and oral consent of the participant after clear and fair information on the study

 Exclusion Criteria:

 -  The persons concerned by the articles L.1121-5 to L1121-8 and L.1122-1-2 of the Code
 de la santé publique will not be included in the interviews of the qualitative
 studies.