CHOICE: Communicating Health Options Through Information and Cancer Education
Condition: Colorectal Neoplasms
MeSH terms: Colorectal Neoplasms
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to determine the effectiveness of a two-component intervention,
      that combines academic detailing at the medical practice level and distribution of decision
      aids at the patient level, on adherence to colorectal cancer screening guidelines.
    

Detailed description: 
      Colorectal cancer is the second most common cause of cancer death in the United States. Early
      detection and intervention can significantly reduce morbidity and mortality from colorectal
      cancer (CRC), and current guidelines recommend that asymptomatic adults over age 50
      periodically obtain screening by one of several modalities (FOBT, sigmoidoscopy, colonoscopy,
      or double contrast barium enema). However, CRC screening remains substantially underutilized
      in the U.S., and more than half of all adults do not adhere to these recommendations. This
      study was designed to increase CRC screening among health plan members, and involves the
      collaboration of a major health insurer.

      We are conducting a cluster-randomized trial in health practices in Georgia and Florida, to
      test the effectiveness of a decision aid (video + brochures) for increasing adherence to CRC
      screening guidelines. Thirty-two large group practices were recruited and randomized to
      receive usual care (routine reminders) or an evidence-based decision aid intervention. In
      each practice, patients between the ages of 52 and 75, without current CRC screening history,
      were enrolled into the study.

      In early 2007, we received a full HIPAA waiver that permitted us to send the decision aid
      intervention to long-term non-responders in the intervention group, and to access claims data
      for this group and the long-term non-responders in the usual care group. This procedure will
      make it possible for us to learn more about the real-world impact of the intervention.

      The intervention will continue for up to 2 years for still-unscreened participants. The main
      outcome is receipt of an evidence-based modality of CRC screening according to the US
      Preventive Services Task Force Guidelines (FOBT, flexible sigmoidoscopy, colonoscopy, or
      double contrast barium enema).

      Unique features of the proposed study include its potential to establish systems to increase
      screening uptake that will help fulfill HEDIS requirements; improving our understanding of
      how screening promotion interventions work in both White and Black populations; collaboration
      with a community partner of the Emory Prevention Research Center, and forging collaborative
      relationships between public health and health care researchers, and the affected communities
      of health plans and health care providers.
    

Intervention name(s): Academic Detailing (Medical Practices)+Decision Aids (Patients)
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single
Keywords: Academic Detailing; Decision Aid; Colorectal Cancer Screening; RECTAL NEOPLASMS; COLONIC POLYPS