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    A Telephone Call Can Make All the Difference

    What does it take to motivate you to do what it takes to stay healthy?

    Gastroenterology researchers at more than 30 hospitals nationwide hypothesized that a phone call to those at higher-than-normal risk for colorectal cancer might be enough to encourage them to get screening tests.

    "We know (from earlier studies) that there are three tenets when it comes to making a person participate in screening activities," said Dr. Ned Colange of Kaiser Permanente in Denver. "There is information - what you know about a subject. The others are to what degree do you feel you are susceptible to a disease, and to what degree do you think you can help yourself."

    Armed with this information, the researchers designed a study to see if calling first-degree relatives (parents, children, siblings) of colorectal cancer patients would motivate them to get colorectal cancer screening. They presented their findings at the Digestive Disease Week conference in San Diego.

    "(The public) pretty well knows that people who are first-degree relatives of those with breast cancer are at increased risk for getting breast cancer, but not for colon cancer," Colange said. "We wondered if people knew they were at increased risk and if participating in screening would reduce the risk, would this motivate people to get screened?"

    Unlike breast cancer, colon cancer screening can identify pre-cancerous conditions - mainly polyps - before they become cancerous. There are several methods of screening: a test for hidden (occult) blood in the stool; a new test that examines intestinal mucus; barium enema x-ray; sigmoidoscopy (a short scope inserted into the bowel; done in the office); and a colonoscopy (a long scope done under light anesthesia; about $1,000).

    Out of nearly 2,100 first-degree relatives contacted, about 1,300 completed the initial interview. Of these, 45 percent said they had undergone some form of colorectal cancer screening within the year.

    The 1,300 participants were assigned randomly to either the intervention group, which received counseling phone calls about colorectal cancer and screening, or the control group, which did not. About 600 patients completed the final telephone interview, during which the volunteers were asked whether they had participated in a screening during the year of the study.

    In the intervention group, 72 percent of the participants had received some kind of screening for colorectal cancer; in the control group, only 57 percent had been screened.

    "A brief, telephone-based, educational and counseling intervention significantly improved adherence to colorectal cancer screening recommendations for first-degree relatives of colorectal cancer patients," the researchers reported.

    Although the results need to be analyzed further, Colange has some educated guesses about what researchers might find. For instance, "we spent an impressive amount of time talking with the participants about anxiety," he said - whether educating first-degree relatives about their higher risk caused anxiety or not.

    "The results are not in yet," he added, "but one thing I can say is that in men, talking about it didn't provoke anxiety. And I can't say yet whether men failed more often to get screening, but I feel that that's what we're going to find. They just don't care. They just aren't prevention-oriented. Part of the problem is perceived susceptibility. It will always be the other man who gets cancer."

    Perhaps we shouldn't blame men completely, Colange explained. Women see doctors much more often because of reproductive health issues. In addition to obstetrical needs, "it is part of our culture for women to seek yearly pap smears and mammograms."

    Men, on the other hand, have no similar reasons, at least yet, for seeing a physician regularly although there has been some recent focus on prostate screening.

    There are other barriers - for both sexes - to obtaining colorectal cancer screening: expense; too little time; and the feeling that screening procedures are too degrading.



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