Effects of personalized colorectal cancer risk information on laypersons' interest in colorectal cancer screening: The importance of individual differences

Abstract

Objective: To evaluate how personalized quantitative colorectal cancer (CRC) risk information affects laypersons' interest in CRC screening, and to explore factors influencing these effects.

Methods: An online pre-post experiment was conducted in which a convenience sample (N=578) of laypersons, aged >50, were provided quantitative personalized estimates of lifetime CRC risk, calculated by the National Cancer Institute Colorectal Cancer Risk Assessment Tool (CCRAT). Self-reported interest in CRC screening was measured immediately before and after CCRAT use; sociodemographic characteristics and prior CRC screening history were also assessed. Multivariable analyses assessed participants' change in interest in screening, and subgroup differences in this change.

Results: Personalized CRC risk information had no overall effect on CRC screening interest, but significant subgroup differences were observed. Change in screening interest was greater among individuals with recent screening (p=.015), higher model-estimated cancer risk (p=.0002), and lower baseline interest (p<.0001), with individuals at highest baseline interest demonstrating negative (not neutral) change in interest.

Conclusion: Effects of quantitative personalized CRC risk information on laypersons' interest in CRC screening differ among individuals depending on prior screening history, estimated cancer risk, and baseline screening interest.

Practice implications: Personalized cancer risk information has personalized effects-increasing and decreasing screening interest in different individuals.

Keywords: Colorectal cancer; Personalized risk information; Screening.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to report.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Screenshots of sample risk estimate output from Colorectal Cancer Risk Assessment Tool (CCRAT).

Figure 2. Change in colorectal cancer screening interest in different subgroups of individuals following use of the Colorectal Cancer Risk Assessment Tool (CCRAT)

Model-adjusted means and p-value for effect of prior colorectal cancer (CRC) screening on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Prior CRC Screening – colonoscopy or flexible sigmoidoscopy in past 10 years Model-adjusted means and p-value for effect of model-estimated lifetime risk of colorectal cancer (CRC) on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Low Risk – 7% lifetime risk of CRC Model-adjusted means and p-value for effect of baseline colorectal cancer (CRC) screening interest on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Lowest Interest (Level 1) – “Not at all” response to baseline CRC screening interest question (“How interested are you in getting tested, or “screened,” for colon cancer?”); Highest interest (Level 5) – “Extremely” response to baseline screening interest question

Figure 2. Change in colorectal cancer screening interest in different subgroups of individuals following use of the Colorectal Cancer Risk Assessment Tool (CCRAT)

Model-adjusted means and p-value for effect of prior colorectal cancer (CRC) screening on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Prior CRC Screening – colonoscopy or flexible sigmoidoscopy in past 10 years Model-adjusted means and p-value for effect of model-estimated lifetime risk of colorectal cancer (CRC) on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Low Risk – 7% lifetime risk of CRC Model-adjusted means and p-value for effect of baseline colorectal cancer (CRC) screening interest on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Lowest Interest (Level 1) – “Not at all” response to baseline CRC screening interest question (“How interested are you in getting tested, or “screened,” for colon cancer?”); Highest interest (Level 5) – “Extremely” response to baseline screening interest question

Figure 2. Change in colorectal cancer screening interest in different subgroups of individuals following use of the Colorectal Cancer Risk Assessment Tool (CCRAT)

Model-adjusted means and p-value for effect of prior colorectal cancer (CRC) screening on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Prior CRC Screening – colonoscopy or flexible sigmoidoscopy in past 10 years Model-adjusted means and p-value for effect of model-estimated lifetime risk of colorectal cancer (CRC) on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Low Risk – 7% lifetime risk of CRC Model-adjusted means and p-value for effect of baseline colorectal cancer (CRC) screening interest on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Lowest Interest (Level 1) – “Not at all” response to baseline CRC screening interest question (“How interested are you in getting tested, or “screened,” for colon cancer?”); Highest interest (Level 5) – “Extremely” response to baseline screening interest question

Figure 3. Combined effects of model-estimated colorectal cancer risk and baseline colorectal cancer screening interest on change in screening interest following Colorectal Cancer Risk Assessment Tool (CCRAT) use

Model-adjusted means for combined effects of model-estimated lifetime colorectal cancer (CRC) risk and baseline screening interest on change in screening interest in multivariable ANCOVA model adjusting for age, sex, race, prior CRC screening, model-estimated CRC risk, and baseline interest in CRC screening Lowest Risk – 7% lifetime risk of CRC Lowest Interest – “Not at all” response to baseline CRC screening interest question (“How interested are you in getting tested, or “screened,” for colon cancer?”); Highest interest – “Extremely” response to baseline screening interest question