Post written by Ker-Kan Tan, PhD, from the Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore. 

The aim of this study was twofold. First, we sought to understand if colorectal cancer (CRC) patients would be willing to advocate cancer screening to their siblings (who would be considered higher-risk, first-degree relatives [FDRs]). Second, we wanted to evaluate if siblings would be more willing to undergo cancer screening if made aware of the national screening guidelines for FDRs of CRC patients.

FDRs of CRC patients are known to have an estimated 2-times-higher lifetime risk of developing CRC compared to the general average-risk population, due to family history. However, we noted that few interventions specifically targeting FDRs’ awareness and willingness to screen for CRC were in place, whether in Singapore or around the world.

We also realized that, although it seemed intuitive that CRC patients would encourage their FDRs to go for screening, this assumption was unsupported in our previous research.

We therefore sought to conduct a randomized controlled, behavioral trial to see if patients would be willing advocates of screening to their FDRs, and whether an education intervention package tailored for FDRs would be significantly more effective in encouraging FDRs to contact us for CRC screening.

We found that CRC patients, regardless of being assigned to intervention or control groups, were highly willing (approximately 90% of sample) to advocate CRC screening to their FDRs. However, although FDRs who received the tailored intervention package were more likely to respond or contact us, overall FDR response rates were low (14.3%). We also found that FDRs who were aged 60 years or older were significantly less likely to contact us.

We felt that the study highlighted CRC patients as a potential avenue to spread awareness about CRC screening to their friends and loved ones. However, the low FDR response rate suggests that patient-led advocacy should be used as a complementary adjunct in a multi-pronged suite of screening promotion modalities.

CONSORT flow diagram.

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