Interactions among physicians, patients, and first-degree relatives in the familial screening of colorectal cancer in France

Aims: To characterize determining factors for compliance with colonoscopy recommendations in the familial screening of colorectal cancer through exploration of individual psychosociological factors and issues relating to patient/physician/sibling communication.

Methods: A qualitative approach involving a review of the literature and interviews with general practitioners, specialists, patients, and their siblings.

Results: A confrontation of the content of interviews with data from the literature made it possible to confirm the relevance of classic prevention models, the Health Belief Model and the Theory of Planned Behavior in the French cultural and healthcare environments, as well as their ability to identify the main individual factors liable to motivate or to discourage familial screening. The family network plays a decisive part in the transmission of information from the patient towards siblings. Physicians have expectations relating to communication aids and backup. This study above all highlights the difficulty in determining who is best suited to giving information to the patient, and when and how to relay this information to first-degree relatives.

Conclusion: In view of the many difficulties in establishing interaction between patient, physician and siblings that is liable to lead on to efficient screening, we propose the study of the usefulness of a health-counseling intervention aimed to tailor and follow-up the delivery of screening information to the first-degree relatives.