Good News! Kudos to Isaac Lipkus, professor, and his entire team for the submission of their NIH R01 application entitled: "Facilitating and reactions to family communications to promote colon cancer screening among first degree relatives with a family history of advanced adenomas: A test of the FamilyTalk online tool." This proposal requests funding for a three-year period with a start date of 9/1/2021.

First degree relatives (FDRs) with a family history of advanced adenomas, that is, polyps of high malignant potential, are at higher risk for colorectal cancer (CRC). Thus, more aggressive screening surveillance is warranted, especially at younger ages. Screening rates among these FDRs is virtually unknown and likely poor because most will lack awareness of their family history and increased risk. Further, screening interventions targeting these FDRs is almost nonexistent. To this end, having patients with AAs convey to their FDRs their at-risk status leverages family relationships to increase CRC screening. These communications are infrequent and hindered by patients’ lack of awareness of their own and FDRs' heightened CRC risk due to AAs and uncertainties about how to convey increased CRC risks and discuss screening.

To address communication about CRC risk among family members, we created “FamilyTalk” (Famtalk), an online program focused on genetic testing for CRC in families with a history of CRC. Famtalk provides facts and tools to facilitate understanding and communications of familial CRC risks and screening. However, Famtalk lacks coverage of AAs. We propose to revise Famtalk to be significantly more responsive to the educational needs and family communication issues surrounding AAs - and in doing so make it more versatile to address both family history of CRC and AA. A revised Famtalk is predicted to spur patient/family communications with FDRs and in so doing promote CRC screening. To obtain preliminary data on the efficacy of the revised Famtalk, we evaluate two key intermediate endpoints: 1) occurrence of communications between patient/family members and FDRs on AA/CRC risks and CRC screening; and 2) effect of these communications on FDRs’ CRC screening intentions among those noncompliant with screening. In Step1, we will add to Famtalk details about AAs (e.g., what are they, risks of AAs); patients who were diagnosed with at least one AA will review the content. In Step 2, we will recruit 390 patients with at least one AA who have not conveyed their result or risk implications to their FDRs. Patients will be randomized 2 to 1 to either FamTalk or to usual care (i.e., patient was informed of test result and when to return for a repeat colonoscopy). We will also enroll one FDR who is off schedule for CRC screening per patient. Patients will complete a baseline and a two-month post-baseline online survey that will capture if communications about AAs/CRC risk, and/or CRC screening occurred between the patient, family members and FDRs. FDRs will complete an online survey two months after patient baseline that will assess reactions to family discussion about AAs/CRC risk and screening. Overall, promoting CRC screening among FDRs of patients with AAs has been a missed opportunity. Similar to cascade screening, we wish to devise strategies that leverage family relationships and communications to increase CRC screening among individuals who have a FDR diagnosed with AA. Famtalk can fulfill this unique niche.

Thank you to all those who gave their time and expertise in guiding the application process as well as to all those who helped to prepare for this submission.