Research article
Promoting Colorectal Cancer Screening Discussion: A Randomized Controlled Trial

https://doi.org/10.1016/j.amepre.2012.11.032Get rights and content

Background

Provider recommendation is a predictor of colorectal cancer (CRC) screening.

Purpose

To compare the effects of two clinic-based interventions on patient–provider discussions about CRC screening.

Design

Two-group RCT with data collected at baseline and 1 week post-intervention.

Setting/participants

African-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics.

Intervention

Participants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit.

Main outcome measures

Between-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012.

Results

Compared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05).

Conclusions

The computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient–provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP.

Trial registration

This study is registered at www.clinicaltrials.gov NCT00672828.

Introduction

Tailored interventions are more effective than nontailored materials in promoting behavior change, including cancer screening.1, 2, 3, 4, 5 The current RCT compared the efficacy of a clinic-based, computer-delivered tailored interactive program with a nontailored brochure to promote patient–provider discussions about colorectal cancer (CRC) screening among African-American patients. Demographic, clinic, and health belief variables were examined as predictors of a discussion. CRC screening test orders written during the visit also were examined. It was hypothesized that (1) individuals who received the computer-delivered tailored intervention would be more likely to engage in CRC screening discussions with their primary care provider (PCP) than those in the brochure group and (2) PCPs of individuals who received the computer-delivered tailored intervention would be more likely to write orders for colon tests than PCPs of those in the brochure group.

Section snippets

Methods

A total of 693 African-American patients of 118 PCPs were enrolled between 2008 and 2010. Patients were eligible if they self-identified as black or African-American and were aged 51–80 years, English-speaking, and currently non-adherent to CRC screening guidelines. Exclusion criteria were personal history of CRC or adenomatous polyps requiring surveillance colonoscopy; medical condition precluding CRC screening; cognitive, speech, or hearing impairment; and current adherence to CRC screening

Results

Baseline demographic data are listed in Table 1. Of the 693 primary care patients who received interventions (319 in the computer group, 340 in the brochure group), 659 (95%) completed the 1 week post-intervention interview. Univariate analysis of intervention effects on patient–provider discussions is presented in Table 2. Compared to those who received the nontailored brochure, participants who received the computer-delivered tailored intervention were more likely to report having engaged in

Discussion

This study compared efficacy of two clinic-based interventions to stimulate patient-reported CRC screening discussions between African-American primary care patients and their PCPs. Individuals who received the computer-delivered tailored intervention had higher odds of reporting a colon test discussion with their PCP and were more likely to have a CRC screening test ordered during the visit. This study is novel because of its focus on evaluating efficacy of an interactive CRC screening

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