Initiation of Colon Cancer Screening in Veterans or "Start Screening Now"
Condition: Colorectal Neoplasms
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      Initiation of colon cancer screening in veterans is a theory-based stepped intervention to
      increase first time colorectal cancer screening (CRCS) among male and female veterans age 50
      and over.
    

Detailed description: 
      Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the US and risk
      increases with age. Colorectal cancer screening (CRCS) offers the possibility of both early
      detection and prevention. For those at average risk, CRCS beginning at age 50 is recommended.
      However, awareness and use of CRCS tests are low. We propose to conduct a randomized
      controlled trial to develop and test stepped interventions to increase initial uptake of CRCS
      in a nationally-representative, ethnically-diverse sample of male and female veterans. Our
      specific aims are to: (1) develop and pre-test stepped intervention components that are
      theory and evidence-informed; (2) implement and evaluate the process, efficacy, and
      cost-effectiveness of stepped interventions to increase an initial CRCS among male and female
      veterans aged 50-64 years; and (3) analyze the association between predictor variables and
      CRCS initiation and the mediating and moderating effects of the interventions, after each
      step. In Step 1, we will evaluate a theory-based minimal cue delivered by a letter, telephone
      call, or automated telephone call compared with a survey-only control group to determine
      whether the 3 different delivery channels are equally efficacious and cost-effective. Minimal
      cues are a cost-effective method that prompts to action those more willing to change and are
      easy to disseminate in real-world settings. Persons who do not complete CRCS in Step 1 will
      be randomized in Step 2 to more intensive interventions that address resistance. In Step 2 we
      will determine whether a theory-based, tailored telephone intervention, using principles of
      Motivation Interviewing, is effective when delivered as part of a sequential intervention
      process in which early adopters have been removed from the population. Step 2 also will
      determine whether an automated approach, telephone-linked communication (TLC), is as
      effective as a telephone counselor in promoting initiation of CRCS. Steps 1 and 2 together
      will address the important issue of the "dose" needed to encourage completion of CRCS. After
      each step, we will examine the mediating and moderating effects of the intervention to
      identify determinants of completion. For cancer screening intervention research to have the
      broadest public health impact, interventions must have the potential for dissemination. We
      designed our trial to move us toward the goal of disseminable interventions with evidence of
      external validity.
    

Intervention name(s): Stepped CRCS Interventions; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In Step 1, we will evaluate a theory-based minimal cue delivered by a letter, telephone call, or automated telephone call. Persons who do not complete CRCS in Step 1 will be randomized to Step 2 using principles of Motivation Interviewing. Step 2 also will determine whether an automated approach, telephone-linked communication (TLC), is as effective as a telephone counselor in promoting initiation of CRCS. Steps 1 and 2 together will address the important issue of the "dose" needed to encourage completion of CRCS.; A survey-only control arm will be compared to the experimental arm to determine whether the 3 different delivery channels are equally efficacious and cost-effective.
Other intervention name(s): Start Screening Now
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Participant)
Primary purpose: Screening
Keywords: Colorectal Neoplasms; Mass Screening; Patient Compliance; Intervention Studies; Clinical Trial