Interventions to Improve Colon Cancer Screening in Poor Rural Iowa Counties
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      The goal of the study is to conduct a randomized clinical trial to test several office-based
      strategies for improving colon cancer screening among individuals who are regular patients at
      16 family practice physician offices in the state of Iowa. These offices are members of the
      Iowa Research Network (IRENE), a rural practice-based research network. The interventions to
      be tested are increasing in intensity from the usual care provided in the office, to
      physician chart reminders, mailed educational materials to patients, a fecal immunochemical
      test with postage-paid return envelope, and a telephone call designed to determine attitudes
      and barriers to screening, and to motivate subjects to get screened. Our main research
      questions are: 1)do attitudes toward CRC screening change after providing educational
      materials about CRC screening? 2)do mailed educational materials and a FIT, with or without a
      telephone reminder, result in increased rates of CRC testing with the FIT?
    

Detailed description: 
      Colorectal cancer is the second leading cause of cancer death in the U.S. yet approximately
      half of eligible adults are not up-to-date with colon cancer screening and the rates of
      screening are lower among those with lower incomes and who lack insurance. A physician's
      recommendation for screening has consistently been show to be one of the most powerful
      predictors of CRC screening. Relatively few studies of CRC screening have been conducted in
      primary care. Disparities in CRC screening rates are seen in low socioeconomic and rural
      individuals who often lack resources and access to screening. Most intervention studies have
      been conducted in managed care settings, community health centers, Veteran's Administration
      or academic practices. Few studies have looked at interventions in rural medical practices.
      This research will address screening issues for rural patients and those residing in
      communities designated as medically underserved. The interventions tested in the study will
      focus on two key areas: educating the patient about the importance of screening, and
      reminding the physician about the need to discuss screening during the patient's visit.

      The original goal of the study was to enroll 1500 unscreened patients aged 52 to 79 years
      from 16 family physician practices located in poor, rural Iowa counties. This study will test
      a combination of patient and physician reminder strategies designed to ensure that the
      patient is educated about CRC screening and receives a recommendation for CRC screening from
      their physician. The main outcome is colorectal cancer screening by any of the accepted
      methods. Rates of screening will be compared across intervention groups. We will also
      determine how much the interventions cost per person screened.

      Patients due for screening within each practice (based on their self-report) (never screened
      or not up to date with screening) will be randomized to one of four groups that will receive
      office reminder system strategies of increasing intensity: 1) Usual care, 2) Physician chart
      reminder alone, 3) Physician chart reminder plus multifaceted mailed patient education,
      including a postage paid fecal immunochemical test, a reminder magnet, and returnable CRC
      screening test preference sheet, or 4) Physician chart reminder + multifaceted mailed patient
      education/FIT/magnet/preference sheet + telephone reminder to encourage screening and address
      barriers.

      Our central hypothesis is that providing offices with one or more CRC screening support
      systems based on the Chronic Care Model will significantly increase CRC screening rates in
      comparison with usual care, and that such interventions will be cost-effective and accepted
      in practice.
    

Intervention name(s): Physician chart reminder; chart reminder, educational mat'ls, FIT; CR,ed mat'ls, FIT, phone call
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Subjects randomized to this intervention will have paper or electronic chart reminders placed on their medical records alerting their physicians to the need for colorectal cancer screening; Subjects randomized to this group will have a physician chart reminder, mailed educational packet which includes the CDC Screen for Life materials, a FIT with return envelope, a magnet to remind the subject about CRC screening and a CRC screening preference sheet; Subjects randomized to this group will have a physician chart reminder, mailed educational packet which includes the CDC Screen for Life materials, a FIT with return envelope, a magnet to remind the subject about CRC screening and a CRC screening preference sheet. Subjects will also receive a telephone call from project staff to assess barriers to screening and to encourage CRC screening
Other intervention name(s): chart reminder; chart reminder, mailed education, FIT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Screening
Keywords: colorectal cancer; screening; colonoscopy; fecal immunochemical test; clinical guidelines