Use of family history to improve colorectal cancer screening outreach among Alaska Native people

Abstract

Colorectal cancer (CRC) incidence and mortality among Alaska Native people are the highest of any ethnic or racial group in the United States. First-degree relatives (FDRs), which include parents, siblings, and children of CRC patients, are at increased risk. There is a paucity of data on predictors of screening adherence among Alaska Native FDRs, and the extent to which screening outreach is occurring within the Alaska Tribal Health System (ATHS) for FDRs. There is also a lack of data available on barriers and facilitators to increasing screening outreach efforts in this population. This study assessed the prevalence of CRC screening outreach to FDRs at Alaska tribal health organizations (THOS), use of family history information, barriers to CRC screening, and potential tools to improve CRC screening throughout the Alaska Tribal Health System (ATHS). The study also included a process evaluation of the Alaska Native CRC Family Outreach Program (2000-2012) based in Anchorage, Alaska. The process evaluation investigated the program's formation, evolution, and successes and challenges through a series of key informant interviews with program stakeholders. Lastly, an outcome evaluation was conducted of the Alaska Native CRC Family Outreach Program to assess predictors of screening adherence and results of screening among Alaska Native FDR program participants. The study found that CRC screening outreach was common in the ATHS, but significant barriers still exist. These barriers were especially notable for outreach to FDRs, including a lack of dedicated staff and resources. Key results of the process evaluation of the Alaska Native CRC Family Outreach Program included an incremental approach that led to a unique outreach program and revealed the need for dedicated staff to provide culturally competent patient navigation. Challenges identified included differing FDR outreach responses, health system data access and coordination, and relying on unstable grant funding for program sustainability. The outcome evaluation of the Alaska Native CRC Family Outreach Program found despite increasing programmatic outreach and FDR screening rates, a large proportion of Alaska Native FDRs were still due for screening. This was especially true among rural-dwelling and older FDRs. This study found that overall, CRC screening and awareness are increasing among the Alaska Native population, including among FDRs. However, many Alaska Native FDRs remain unscreened. There is a critical need for more research into FDR barriers and facilitators to CRC screening, as well as how the ATHS can more systematically promote screening among this increased-risk population and reduce morbidity and mortality due to this preventable disease.