A Randomized Controlled Trial of a Tailored Navigation and a Standard Intervention in Colorectal Cancer Screening

Abstract

Background This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer (CRC) screening adherence and screening decision stage (SDS). Methods Primary care patients (n=945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n=312), Standard Intervention (SI) Group (n=316), or usual care Control Group (n=317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months. Results The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (p=0.001 and p=0.001, respectively), but the two intervention groups did not differ significantly (p=0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (p=0.001 and p=0.001, respectively), and the intervention group difference approached significance (p=0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options. Conclusions Both interventions had significant, positive effects on outcomes compared to usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS. Impact Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.

Sociopsychological Tailoring to Address Colorectal Cancer Screening Disparities: A Randomized Controlled Trial

“…Of previous randomized controlled trials comparing a sociopsychologically tailored colorectal cancer screening intervention with an active control, 15,19,20,22,[25][26][27][28][29][30]33 only some reported improvements in screening, 19,25,28,29,34 in most instances based on patient report, 19,25,28,29 suggesting possible misclassification bias. These observations, plus our current findings, raise doubts about the superiority of sociopsychological tailoring to nontailored approaches in promoting colorectal cancer screening.…”

“…[10][11][12][13][14][15][16][17][18][19][20][21][22] Whether enhancement of sociopsychological factors influences health behaviors is uncertain. 12,13,19,[22][23][24][25][26][27][28][29][30][31][32] Among trials comparing patients receiving sociopsychologically tailored colorectal cancer screening interventions with active control, 15,19,20,22,[25][26][27][28][29][30]33 only some found superior effects of tailoring 19,25,28,29,34 ; in all but 1 trial 34 screening was self-reported, 19,25,28,29 suggesting possible response bias. There is a need to examine further whether objectively measured colorectal cancer screening improves in response to sociopsychologi...…”

Personal Navigation Increases Colorectal Cancer Screening Uptake

“…Navigation interventions have variously used telephone contact with the patient population or referral of patients by primary care physicians to meet with navigators at the time of routine office visits (1)(2)(3)(4). While the current study is aligned with RCTs where a navigator attempted to contact primary care patients (outside routine visits), our navigation approach accommodated face-to-face or telephone contacts.…”

“…When Myers and colleagues compared a preference-based intervention with a mailed intervention, where subjects solely received multiple options and no navigation toward preference, the subjects randomized to the preference-based TNI had higher rates than no-intervention controls (TNI, 38%; control, 12%) but the multiple-options group demonstrated a screening rate only 5% lower (38% vs. 33%) (2). Subsequent analyses evaluated the independent effects of the multiple-option mailing versus the telephone navigation for SBT, with the multiple-option mailing associated with increased screening (OR ¼ 2.6, P ¼ 0.001) due to a 29-fold increase in SBT, while telephone navigation was associated with increased screening (OR ¼ 2.1, P ¼ 0.005) due to a 3-fold increase in colonoscopy.…”

“…In colorectal cancer screening projects, mailed contacts (with or without included screening kits), office contacts, and combined telephone-office contacts have increased uptake (1)(2)(3)(4), with literature reviews indicating increased colorectal cancer screening rates (5-8) via mailings [e.g., printed materials, mailed stool blood tests (SBTs), reminder mailings], whereas recently reported randomized controlled trials (RCTs) show that personal contacts and mailings significantly increase rates in different patients (1)(2)(3)(4). Accordingly, personalized patient contacts (i.e., navigation) appear a promising strategy.…”