A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening

Abstract

BACKGROUND.Colorectal cancer screening is underutilized. The objective of the current study was to determine whether targeted and tailored interventions can increase screening use.METHODS.A total of 1546 primary care practice patients completed a baseline telephone survey and were randomized to 4 study groups: control (387 patients), Standard Intervention (SI) (387 patients), Tailored Intervention (TI) (386 patients), or Tailored Intervention plus Phone (TIP) (386 patients). The control group received usual care throughout the study. The SI group received a targeted intervention by mail (ie, screening invitation letter, informational booklet, stool blood test, and reminder letter). The TI group received the targeted intervention with tailored “message pages.” The TIP group received the targeted intervention, tailored message pages, and a telephone reminder. Intervention group contacts were repeated 1 year later. Screening was assessed 24 months after randomization.RESULTS.Screening rates in study groups were 33% in the control group, 46% in the SI group, 44% in the TI group, and 48% in the TIP group. Screening was found to be significantly higher in all 3 intervention groups compared with the control group (odds ratio [OR] of 1.7 [95% confidence interval (95% CI), 1.3–2.5], OR of 1.6 [95% CI, 1.2–2.1], and OR of 1.9 [95% CI, 1.4–2.6], respectively), but did not vary significantly across intervention groups. Multivariate analyses demonstrated that older age, education, past cancer screening, screening preference, response efficacy, social support and influence, and exposure to study interventions were positive predictors of screening. Having worries and concerns about screening was found to be a significant negative predictor.CONCLUSIONS.Targeted and tailored interventions were found to increase colorectal cancer screening use. However, additional research is needed to determine how to increase the effect of such interventions in primary care. Cancer 2007. © 2007 American Cancer Society.

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

“…Consistent with other studies in Australia (Cole, Smith, Wilson, Turnbull, Esterman, & Young, 2007;Cole, Young, & Byrne, 2002;Zajac, Whibley, Cole, Byrne, Guy, Morcom et al, 2010) and internationally (Brouse et al, 2003;Damery, Clifford, & Wilson, 2010;Federici, Rossi, Bartolozzi, Farchi, Borgia, & Guastcchi, 2006;Ferreira, Dolan, Fitzgibbon, Davis, Gorby, Ladewski et al, 2005;Klabunde, Frame, Meadow, Jones, Nadel, & Vernon, 2003;Myers, Sifri, Hyslop, Rosenthal, Vernon, Cocroft et al, 2007;Rossi et al, 2005;Vernon, 1997), our study also revealed that doctor's recommendation and endorsement is one of the strongest predictors of CRC screening. Studies in the UK which use sigmoidoscopy as the method of CRC screening also highlight the importance of GP endorsement and recommendation (Brotherstone, Vance, Edwards, Miles, Robb, Evans et al, 2007;McCaffery, Borril, Williamson, Taylor, Sutton, Atkin et al, 2001;Power, Van Jaarsveld, McCaffery, Miles, Atkin, & Wardle, 2008;Robb, Power, Kralj-Hans, Edwards, Vance, Atkin et al, 2010;Sutton, Wardle, Taylor, McCaffery, Williamson, Edwards et al, 2000), although the relevance of these studies may be questioned due to the different type of CRC screening test used.…”

A Randomized Controlled Trial to Improve Colon Cancer Screening in Rural Family Medicine: An Iowa Research Network (IRENE) Study

“…48 Another study tested various interventions to increase screening using FOBT and randomized patients to usual care, a standard mailed intervention, a tailored mailed intervention, or a tailored intervention plus telephone reminder. 38 FOBT rates increased to 44% to 48% in all intervention groups but were not significantly different from each other, indicating that, similar to our study, the telephone call had no added effect. 38 We found a few practice-based studies that assessed strategies similar to ours.…”

“…38 FOBT rates increased to 44% to 48% in all intervention groups but were not significantly different from each other, indicating that, similar to our study, the telephone call had no added effect. 38 We found a few practice-based studies that assessed strategies similar to ours. One study included 21,860 patients from 14 ambulatory practices in the Harvard Vanguard Medical Associates system; the patients all were overdue for CRC screening and were randomized to mailed education with 3 guaiac FOBT cards versus no mailed education.…”

Mailed Fecal Immunochemical Tests Plus Educational Materials to Improve Colon Cancer Screening Rates in Iowa Research Network (IRENE) Practices

“…Myers et al 29 randomized 1546 primary care patients due for CRC screening at a single university medical practice to 1 of 4 groups: usual care (no mailed materials); standard mailed education plus FIT; mailed tailored intervention, FIT, plus reminder letter; and mailed tailored intervention, FIT, and a telephone reminder. Rates of any CRC testing 24 months after randomization were 33% in the control group, and 44% to 46% in the intervention groups.…”