Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract

Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

Self-affirmation moderates effects of unrealistic optimism and pessimism on reactions to tailored risk feedback

We examined whether self-affirmation would facilitate intentions to engage in colorectal cancer (CRC) screening among individuals who were off-schedule for CRC screening and who were categorised as unrealistically optimistic, realistic or unrealistically pessimistic about their CRC risk. All participants received tailored risk feedback; in addition, one group received threatening social comparison information regarding their risk factors, a second received this information after a self-affirmation exercise and a third was a no-treatment control. When participants were unrealistically optimistic about their CRC risk (determined by comparing their perceived comparative risk to calculations from a risk algorithm), they expressed greater interest in screening if they were self-affirmed (relative to controls). Non-affirmed unrealistic optimists expressed lower interest relative to controls, suggesting that they were responding defensively. Realistic participants and unrealistically pessimistic participants who were self-affirmed expressed relatively less interest in CRC screening, suggesting that self-affirmation can be helpful or hurtful depending on the accuracy of one's risk perceptions.     

Predicting Participation in Cancer Screening: The Role of Perceived Behavioral Control1

We examined the role played by perceived behavioral control in predicting participation in colorectal cancer screening among individuals recently informed that they were at high risk for this type of cancer. A telephone interview based primarily on the theory of reasoned action was administered to 96 high-risk individuals and 144 average-risk individuals. All participants then were sent materials needed to complete the screening test. In both groups, perceived behavioral control enhanced prediction of intention to complete the test over and above the contributions of attitude and subjective norm. In addition, perceived behavioral control had a direct effect on behavior but only in the high-risk group. Further, for high-risk subjects, knowledge about test procedures moderated the relationship of perceived behavioral control and intention to behavior, but in ways only partially consistent with theory. Finally, the model was better at predicting behavior in the average than in the high-risk group. We conclude that perceived behavioral control plays an important role in the prediction of screening behavior. Perceived behavioral control's motivational role manifests itself unambiguously through its influence on intention. The role of perceived behavioral control above and beyond its influence on intention, however, needs further study and clarification.     

Perceived Versus Predicted Risks of Colorectal Cancer and Self-Reported Colonoscopies by Members of Mismatch Repair Gene Mutation-Carrying Families Who Have Declined Genetic Testing

People carrying germline mutations in mismatch repair genes are at high risk of colorectal cancer (CRC), yet about half of people from mutation-carrying families decline genetic counselling and/or testing to identify mutation status. We studied the association of quantitative measures of risk perception, risk prediction and self-reported screening colonoscopy in this elusive yet high-risk group. The sample of 26 participants (mean age 43.1 years, 14 women) in the Australasian Colorectal Cancer Family Registry were relatives of mutation carriers; had not been diagnosed with any cancer at the time of recruitment and had declined an invitation to attend genetic counselling and/or testing. A structured elicitation protocol captured perceived CRC risk over the next 10 years. Self-reported colonoscopy screening was elicited during a 45-minute semi-structured interview. Predicted 10-year CRC risk based on age, gender, known mutation status and family history was calculated using “MMRpro.” Mean perceived 10-year risk of CRC was 31 % [95 % CI 21, 40], compared with mean predicted risk of 4 % [2, 7] (p?<?0.001); this was independent of age and sex (p?=?0.9). Among those reporting any medical advice and any screening colonoscopy (n?=?18), those with higher risk perception had less frequent colonoscopy (Pearson’s r?=?0.49 [0.02, 0.79]). People who decline genetic testing for CRC susceptibility mutations perceive themselves to be at substantially higher risk than they really are. Those with high perceived risk do not undertake screening colonoscopy more often than those who perceive themselves to be at average risk.     

Cancer Worry,Perceived Risk and Cancer Screening in First-Degree Relatives of Patients with Familial Gastric Cancer

Currently, there is a lack of evidence evaluating the psychological impact of cancer-related risk perception and worry in individuals at high risk for gastric cancer. We examined the relationships between perceived risk, cancer worry and screening behaviors among first-degree relatives (FDRs) of patients with familial gastric cancer. FDRs of patients diagnosed with familial gastric cancer with a non-informative genetic analysis were identified and contacted. Participants completed a telephone interview that assessed socio-demographic information, cancer risk perception, cancer worry, impact of worry on daily functioning, and screening behaviors. Twenty-five FDRs completed the telephone interview. Participants reported high levels of comparative and absolute cancer risk perception, with an average perceived lifetime risk of 54 %. On the other hand, cancer-related worry scores were low, with a significant minority (12 %) experiencing high levels of worry. Study participants exhibited high levels of confidence (median = 70 %) in the effectiveness of screening at detecting a curable cancer. Participants that had undergone screening in the past showed significantly lower levels of cancer-related worry compared to those that had never undergone screening. In conclusion, individuals at high-risk for gastric cancer perceived a very high personal risk of cancer, but reported low levels of cancer worry. This paradoxical result may be attributed to participants’ high levels of confidence in the effectiveness of screening. These findings highlight the importance for clinicians to discuss realistic risk appraisals and expectations towards screening with unaffected members of families at risk for gastric cancer, in an effort to help mitigate anxiety and help with coping.     

Effects of Counseling and Ethnic Identity on Perceived Risk and Cancer Worry in African American Women

Improving breast screening behaviors in African American women is an important public health goal. To increase participation in screening, it is necessary to identify factors that contribute to reduced screening, including perceived risk and cancer worry. This paper presents predictors of changes perceived in risk and worry among African American women of differing ethnic identities as they undergo breast cancer risk counseling. Participants (n = 113) were recruited from community sources to a study of counseling for breast cancer risk. They completed a baseline assessment, randomly received breast cancer risk counseling or served as a control group, and completed a follow-up assessment. Counseling produced significant differences in perceived risk and cancer worry. Predictors of risk and worry changes, as a result of counseling, included income and ethnic identity. These data can guide better services for African American women and research into the complexity of the effects of ethnic identity on health.     

Beyond a Paycheck: The Influence of Workforce Participation on Women’s Cancer Screening in Turkey

The present study investigates the influence of workforce participation on women’s cancer screening behaviors in Turkey. In cultures with predominantly Muslim populations like Turkey, emphasis is typically placed on a woman’s traditional role as a child bearer. Although the impact of workforce participation on women’s welfare has been studied in various contexts, the relationship between workforce participation and health protective behavior has received scant attention. Using quantitative data from a survey of women aged 40 and above from 33 urban cities in Turkey (N?=?483), we examine the influence of workforce participation on breast and cervical cancer screening behaviors. Homemakers were less likely than working/retired women to be up-to-date on screenings. Women with lower income and education screened less; however, workforce participation seemed to have a positive effect on screening among these women. Additionally, working/retired women and homemakers differed from each other in terms of their perceptions regarding their risk of developing cancer (perceived susceptibility). In addition, both perceived susceptibility and women's perceptions regarding their ability to get cancer screening (self-efficacy) were significant predictors of intention to engage in screening in future. In Turkey, homemakers are in a vulnerable position due to lower rates of cancer screening. Furthermore, targeting homemakers for interventions may be easier than trying to identify other low screening groups of women such as those with lower education or income. Interventions raising perceptions of susceptibility to cancer, possibly by targeting neighborhoods during working hours, could be useful in increasing screening rates at risk women.     

Pancreatic Cancer Surveillance Among High-Risk Populations: Knowledge and Intent

Pancreatic cancer is the fourth most common cancer in both men and women in the United States. It has the lowest survival rate of all cancers, largely due to the presence of non-specific symptoms, leading to diagnosis at advanced stages. While the majority of cases of pancreatic cancer are sporadic, up to 10% may be associated with an inherited predisposition. Currently, there is no standard screening protocol for pancreatic cancer, although this will change in the future as technology improves. Additionally, there is little information regarding the perceptions and intent to screen for pancreatic cancer among those with an increased risk due to a hereditary cancer predisposition syndrome, which was the objective of this study. Focus groups and individual telephone interviews were conducted, with questions focused on knowledge about pancreatic cancer and screening, perceived motivators, and perceived barriers related to each of the screening techniques currently available. Participants were recruited from the High Risk Breast Cancer and Pancreatic Cancer Registries at Huntsman Cancer Institute. The findings of this study indicated that individuals from these high-risk groups have low knowledge levels of pancreatic cancer screening, despite their desire for this information. Motivation to undergo a particular screening technique is related to whether the test is recommended by a physician, cost, degree of invasiveness, and comfort level. This information is useful to genetics professionals who counsel at-risk individuals, physicians who formulate patient care plans, and translational researchers who are developing pancreatic screening methods.     

Objective risk, subjective risk, and colorectal cancer screening among a clinic sample

Among cancers, colorectal (CRC) is the third most incident and the second most lethal. Although screening for the disease has been shown to be effective in reducing morbidity and mortality, screening rates remain low. Risk of disease has been shown to increase screening uptake, but different types of risk may influence intent to screen, screening in a timely manner, or participating in screening at all. A cross-sectional design was used to select a diverse sample of CRC asymptomatic patients 50 or more years of age (N=104) visiting one of three Midwestern medical clinics. Results showed a positive relationship between receipt of CRC screening and planning to screen for CRC in the future. Objective risk factors (personal/family history and having a primary care physician) were associated with CRC screening uptake and screening within the time intervals recommended by professional screening guidelines, but subjective risk did not obtain significance for screening participation. Both objective (primary care physician) and subjective risk (long-term comparative risk, knowledge) were associated with future plans to screen. Findings suggest that CRC screening behaviors may be differentially influenced by type of risk.     

Health Behaviors and Psychological Distress in Women Initiating BRCA1/2 Genetic Testing: Comparison with Control Population

The study objective was to compare breast cancer screening practices, lifestyle behaviors and psychological distress among 640 women initiating BRCA1/2 testing to those among 9,498 similarly-aged women from the general population. Health behaviors and psychological distress were reported in a self-administered questionnaire at pre-test genetic counseling. Regression analyses indicate that high-risk women were more frequently performing breast cancer screening and, in the case of those previously diagnosed with cancer, were more likely to be non-smokers and physically active than women from general population. However, women initiating BRCA1/2 testing were significantly more distressed than controls. Globally, high-risk women seemed to be well informed about recommendations for women who are at high risk and to have access to screening adapted to their risk level. Given their significant psychological distress, providing minimal psychosocial support to all women undergoing BRCA1/2 testing at pre-test genetic counseling is relevant.     

Perceptions of High-Risk Care and Barriers to Care Among Women at Risk for Hereditary Breast and Ovarian Cancer following Genetic Counseling in the Community Setting

Data are limited regarding barriers to care among women, with or at risk for hereditary breast and ovarian cancer (HBOC), following genetic counseling in the community setting. Using a telephone survey, we retrospectively addressed perceptions of post-genetic counseling medical care and barriers to care among 69 at-risk women from the non-academic setting. Of these, all agreed that following cancer screening recommendations was better than not following them; none felt recommendations were too difficult to follow; all believed screening would help keep them healthy; 57% believed screening would prevent cancer. Twenty-five percent noted discomfort with breast imaging; 29% found ovarian cancer screening uncomfortable. Close to a quarter of participants reported difficulty deciding whether or not to undergo risk-reducing mastectomy while 10% noted difficulty deciding for or against bilateral salpingo-oophorectomy. There were no perceived major barriers to care, although 38% felt that screening reminders would be helpful, and 10% needed more help in following through with care. Overall, participants believed that they were benefiting from their post-genetic counseling medical care. This work identified HBOC-related support needs to include: informational resources that promote improved understanding of cancer risk and high-risk management; screening reminder systems; and decision support tools.     

Cancer Risk Counseling: How Is It Different?

Fifty-six of 80 (70%) full members of the National Society of Genetic Counselors with interest in cancer genetics responded to a 1994 survey regarding their cancer risk counseling practices. This study was undertaken to describe cancer risk counselors and the services they provide and to identify possible differences from general genetic counseling that warrant further study. Of 56 respondents, 41 (75%) were providing CRC. The components of CRC programs are described. Our results found significant differences between CRC and general genetic counseling in terms of training and experience of genetic counselors providing CRC and length and number of counseling sessions per consultand. 51% of respondents had 1–2 years of working in CRC, compared to 17% with 1–2 years experience in genetic counseling (p<0.05). Over one-third had 10 or more years genetic counseling experience. Counselors were more likely to see individuals at risk for cancer for longer counseling sessions (p<0.05) and for additional sessions (p<0.05).     

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands’ support of their wives’ CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples’ ability to view CRCS as having benefit for the marital relationship.     

Explaining the procedural justice–perceived legitimacy relationship: Relying on relational concern or instrumental concern?

People can extract relational information (i.e., relational concern) as well as instrumental information (i.e., instrumental concern) from decision‐making procedures. Thus, both instrumental and relational concerns are assumed to influence the procedural justice–perceived legitimacy relationship. Drawing from social exchange theory, the different kinds of concerns may lead to form different exchange relationships (social exchange relationship vs. economic relationship), which can be indicated by two forms of trust (affect‐based trust vs. cognition‐based trust). We built a model of trust mediation in which procedural justice predicted affect‐based and cognition‐based trust. Further, we also tested the hypothesis that high (compared with low) group identification individuals are more likely to rely on relational concern to construct procedural justice and judge legitimacy of authority, because they use procedural fairness information to infer the quality of their relationships with the authority. The results of an experiment (Study 1) demonstrated that both affect‐based trust and cognition‐based trust mediated the procedural justice–perceived legitimacy relationship. Moreover, a field study (Study 2) showed that affect‐based trust mediated the relationship between procedural justice and perceived legitimacy primarily among individuals with high group identification whereas cognition‐based trust mediated this relationship primarily among those with low group identification.     

Siblings of individuals with autism spectrum disorders across the life course

In this article, we review the literature on siblings of individuals with autism spectrum disorders (ASD) from a lifespan developmental perspective, from infancy through adulthood, focusing on the sibling relationship and sibling well-being. We situate this review within the larger body of research on siblings of individuals with developmental disabilities (DD) across the lifespan. We then consider the genetic aspects of ASDs and their implications for siblings. We conclude that there is an evidence of atypical social and communication development in some siblings of children with an ASD during infancy. During childhood and adolescence, siblings describe both positive and negative aspects of their sibling relationship and there is some evidence that siblings of children with an ASD may be at heightened risk for social and behavioral adjustment problems. The limited research on adulthood suggests that lack of closeness in the sibling relationship and social and emotional difficulties may continue. We encourage more attention focused on developmental issues, specifically with respect to samples in narrower age groups and in longitudinal research. Finally, we note the variability in sibling outcomes, and suggest further examination of potential moderating and mediating factors, including genetic predispositions.     

个体及同伴调节聚焦对目标追求的影响

探讨个体与同伴的调节聚焦对目标追求的影响及感知相似性在其中的作用。回归分析显示,个体促进聚焦×同伴促进聚焦交互项显著预测同伴作用评价、求助意愿及动机水平,简单斜率分析表明,同伴为高促进聚焦时个体促进聚焦的积极效应更明显。中介分析表明,感知相似性是个体促进聚焦×同伴促进聚焦交互项与同伴作用评价、求助意愿之间关系的中介变量。总的来说,同伴调节聚焦能调节个体调节聚焦与目标追求的关系,且这一作用部分受到感知相似性的中介。