Computerized and Mailed Reminders in Increasing the Rate of Colorectal Cancer Screening in Adults With an Average Risk for Colorectal Cancer
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      RATIONALE: Screening may help doctors find colorectal cancer sooner, when it may be easier to
      treat. Computerized and mailed reminders may help increase the rate of colorectal cancer
      screening in adults with an average risk for colorectal cancer.

      PURPOSE: This randomized clinical trial is studying how well computerized and mailed
      reminders work in increasing the rate of colorectal cancer screening in adults with an
      average risk for colorectal cancer.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  Determine whether rates of colorectal cancer (CRC) screening can be increased among
           average-risk adults by using patient-specific, active, electronic, clinical reminders
           for primary care physicians during office visits and mailed reminders and fecal occult
           blood test cards for patients.

      Secondary

        -  Calculate baseline rates of CRC screening, in terms of patient demographic
           characteristics, primary care physician, and practice group, by using computerized
           clinical information systems to identify patients due for screening.

        -  Assess baseline rates of CRC screening among patients insured by different health plans.

        -  Determine whether the impact of the interventions is related to efforts by health plans
           to promote CRC screening.

        -  Evaluate patients' willingness to use a validated web-based tool to estimate their
           personal risk of CRC.

      OUTLINE: This is a randomized, controlled study. Patients are randomized to 1 of 2 arms (arms
      I or III). Physicians are randomized to 1 of 2 arms (arms II or IV).

        -  Arm I: Patients receive mailed reminders for colorectal cancer (CRC) screening. Patients
           also receive fecal occult blood testing (FOBT) instructions and cards. Patients who
           remain overdue for screening at 6 months after the initial mailing receive a follow-up
           letter reminding them of their need to be screened. Patients who return positive FOBT
           cards undergo colonoscopy within 1 month. The patient's primary care physician may
           receive computerized screening reminders at the time of the patient's office visit and
           may order CRC screening tests online.

        -  Arm II: Patients receive no mailings. The patient's primary care physician may receive
           computerized screening reminders at the time of the patient's office visit and may order
           CRC screening tests online.

        -  Arm III: Patients receive mailed reminders for CRC screening. The patient's primary care
           physician may order CRC screening tests online, but will not receive active computerized
           reminders. Patients also receive FOBT instructions and cards. Patients who remain
           overdue for screening at 6 months after the initial mailing receive a follow-up letter
           reminding them of their need to be screened. Patients who return positive FOBT cards
           will be scheduled to undergo colonoscopy within 1 month.

        -  Arm IV: Patients receive no mailings. The patient's primary care physician may order CRC
           screening tests online, but will not receive active computerized reminders.

      Patients are followed for 15 months to determine screening rates.

      PROJECTED ACCRUAL: A total of 21,860 patients will be accrued for this study.
    

Intervention name(s): counseling intervention; fecal occult blood test; screening colonoscopy
Intervention type(s): Other; Procedure; Procedure
Allocation: Randomized
Primary purpose: Screening
Keywords: colon cancer; rectal cancer