Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center

Khankari, Kishore; Eder, Milton; Osborn, Chandra Y.; Makoul, Gregory; Clayman, Marla L.; Skripkauskas, Silvia; Diamond-Shapiro, Linda; Makundan, Dan; Wolf, Michael S.

doi:10.1007/s11606-007-0295-0

Cited by 85 publications

(112 citation statements)

References 22 publications

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“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

Section: Discussionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

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BACKGROUND:Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE: To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN: Pragmatic randomized trial. PARTICIPANTS: Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS: We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES: Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS: Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS:The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.KEY WORDS: cancer screening; colorectal cancer; breast cancer; outreach; inreach.

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Section: Discussionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

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“…[24][25][26][27][28][29][30][31] Strategies shown to modestly increase preventive cancer screening rates in low income and limited English proficiency populations have included both mailed reminders with educational information for patients and physician-directed efforts to increase recommendation rates. [32][33][34] Recently, "navigator programs" specifically designed to overcome patients' perceived barriers to screening have been evaluated. [35][36][37][38][39] These programs are oriented towards flexible problem solving rather than providing a predefined set of services and often employ bilingual individuals familiar with social and cultural nuances…”

Section: Introductionmentioning

confidence: 99%

A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial

et al. 2008

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“…The physician intervention, a version of which was previously pilot tested in both a Veterans Affairs (VA) internal medicine practice and an FQHC population, [21][22][23] consisted of communication skills training and continuous quality improvement (CQI). The communication skills training was designed to help improve physician communication about CRC and CRC screening among ethnically diverse patients with inadequate or limited health literacy.…”

Section: Interventionsmentioning

confidence: 99%

“…The video was previously pilot tested among both English-speaking and Spanish-speaking patients with limited literacy, and was shown to improve patient knowledge and willingness to consider CRC screening (video available at: http://gim-geriatrics.medicine.northwestern.edu/resources/ get-screened-colorectal-cancer). 22 …”

Section: Interventionsmentioning

confidence: 99%

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

et al. 2015

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BACKGROUND: Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities. OBJECTIVE: Our purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care. DESIGN: This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention. PARTICIPANTS: Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study. INTERVENTION: Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment. MAIN MEASURES: Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test. KEY RESULTS: The physician-patient intervention (n=167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n=183; 61.1 % vs.50.3 %, p=0.008) and usual care (n=153; 61.1 % vs. 34.0 % p=0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p=0.03) and (5.1 % vs. 2.0 %, p=0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests. CONCLUSIONS:Compared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.KEY WORDS: colorectal cancer screening; health literacy; randomized trial; physician communication of preventive care.

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Improving Colorectal Cancer Screening Among the Medically Underserved: A Pilot Study within a Federally Qualified Health Center

Cited by 85 publications

References 22 publications

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

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