Effectiveness of tailored communication intervention in increasing colonoscopy screening rates amongst first-degree relatives of individuals with colorectal cancer: A systematic review and meta-analysis

Ensuring that the first-degree relatives of patients with colorectal cancer are properly screened is critical to reduce disease incidence and mortality rate. Tailored communication intervention is a promising method to induce health-related behavioural changes. However, evidence of the effects of tailored communication interventions on the screening rate of populations at an increased familial risk of colorectal cancer is lacking. This review aimed to identify, appraise and examine existing evidence of the effectiveness of tailored communication interventions in increasing colonoscopy screening rates amongst the first-degree relatives of people with colorectal cancer. Systematic review and meta-analysis. Twelve electronic English and Chinese databases [Medline, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, CINAHL, Scopus, Global Health, British Journal Index, China National Knowledge Infrastructure (CNKI), Wan Fang Data and China Biology Medicine (CBM)] were searched to identify eligible clinical trials that were published over period of 1995 to October 2018. Studies were selected by using key words, such as ʻcolorectal cancerʼ, ʻscreeningʼ, ʻcolonoscop*ʼ, ʻfirst degree relative*ʼ, ʻuptake or adhere*ʼ and ‘cost’. Two reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane Risk of Bias Tool was applied to evaluate the risk of bias amongst included studies. Meta-analysis was performed when possible. Subgroup analysis was performed for types of communication channels. Sensitivity analysis was conducted to explore the influence of random units on the primary outcome. Four studies that adopted tailored communication interventions to increase colonoscopy screening rates were identified. Pooled analysis showed that tailored communication had a beneficial effect on improving colonoscopy use in the colorectal cancer screening context (OR: 2.21, 95% CI: 1.71–2.85, p < 0.01). Furthermore, subgroup analysis showed that repeated tailored communication delivered via print plus telephone call had a significant effect on increasing colonoscopy screening rates (OR: 2.39, 95% CI: 1.78–3.21, p < 0.01). The results of sensitivity analysis indicated that types of randomisation units did not influence outcomes. Tailored communication is a beneficial approach for increasing colonoscopy screening rates amongst first-degree relatives who are at increased familial risk of colorectal cancer. The effective components of tailored communication were repeated contacts, combined verbal and written communication and important tailored variables. Future studies with rigorous designs are recommended to develop an integrated tailoring assessment decision system with the support of Internet-based communication channels.