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

Levy, Barcey T.; Xu, Yinghui; Daly, Jeanette M.; Ely, John

doi:10.3122/jabfm.2013.05.130041

Cited by 49 publications

(50 citation statements)

References 48 publications

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“…Mailed and telephone reminders were most commonly used. 31 We found that mailed patient education resulted in a significant increase in screening in a randomized clinical trial that used system strategies to increase screening across 16 family physicians' offices 16,17,32 ; Sequist et al had similar results with patient mailings to promote CRC screening. 19 …”

Section: Discussionmentioning

confidence: 66%

“…A system strategy is a group of interrelated items that are part of a plan of action to accomplish a specific goal, such as improving CRC screening. Many different system strategies have been identified for improving CRC screening, such as physician recommendation, 13,14 mailed patient reminders, 15-17 and electronic medical record (EMR) physician reminders. 18,19 …”

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confidence: 99%

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System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

et al. 2015

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Objective We assessed the protocols and systems processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHC) in four midwestern states. Methods We identified 49 FQHCs in 4 states. In January, 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC. Results Forty-four (90%) questionnaires were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percent of patients up-to-date with CRC screening was 0.43 (p = 0.01). Conclusions CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain to help prevent or cure many cases of CRC, the second leading cause of cancer in the United States.

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Section: Discussionmentioning

confidence: 66%

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confidence: 99%

System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

et al. 2015

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“…Portions of a colonoscopy review form (available on request) created for previous CRC studies were used for this study. 29–32 Every biopsy sample was classified by size, histology, and location in the colon using the World Health Organization classification system 33 , and those with any villous histology, serrated adenomas, high-grade dysplasia, or any adenomatous polyp 10 mm or greater in diameter were classified as advanced adenomatous polyps. 4,34,35 Our size and histology classifications very closely reflect those used by Imperiale et al 36 and Kim et al 37 Adenomas were classified as “proximal” if in the cecum, ascending colon, hepatic flexure, or transverse colon; they were classified as “distal” if in the splenic flexure or below.…”

Section: Methodsmentioning

confidence: 99%

Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy

Levy

Bay

et al. 2014

J Med Screen

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Background Faecal occult blood tests are often the initial test in population-based screening. We aimed to: 1) compare the results of single sample faecal immunochemical tests (FITs) with colonoscopy, and 2) calculate the sensitivity for proximal vs. distal adenomatous polyps or cancer. Methods Individuals scheduled for a colonoscopy were invited to complete a FIT prior to their colonoscopy preparation. FIT results were classified as positive, negative, or invalid. Colonoscopy reports were reviewed and abstracted. Because of product issues, four different FIT manufacturers were used. The test characteristics for each FIT manufacturer were calculated for advanced adenomatous polyps or cancer according to broad reason for colonoscopy (screening or surveillance/diagnostic). Results Of those invited, 1,026 individuals (43.9%) completed their colonoscopy and had a valid FIT result. The overall sensitivity of the FITs (95% confidence intervals) was 0.18 (0.10 to 0.28) and specificity was 0.90 (0.87 to 0.91) for advanced adenomas or cancer. The sensitivity for distal lesions was 0.23 (0.11 to 0.38) and for proximal lesions was 0.09 (0.02 to 0.25). The odds ratio of an individual with a distal advanced adenoma or cancer testing positive was 2.68 (1.20 to 5.99). The two individuals with colorectal cancer tested negative, as did one individual with high-grade dysplasia. Conclusions The sensitivity of a single-sample FIT for advanced adenomas or cancer was low. Individuals with distal adenomas had a higher odds of testing positive than those with proximal lesions or no lesions.

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“…There are currently 315 active members in 191 primary care offices in 76 of Iowa's 99 Counties. Members of BLINDED have participated in previous CRC research that included predictors of CRC testing [6], a study of office systems for CRC screening [14], and a randomized controlled trial to improve CRC screening [15, 16]. All 22 members participating in these studies who had not received a colon model at a “Lunch and Learns” or training session were sent a colon model.…”

Section: Methodsmentioning

confidence: 99%

Colon Polyp Model Use for Educating About Colorectal Cancer Screening in the Iowa Research Network

Daly

Levy

2014

J Canc Educ

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Providing a model of a colon segment with an adenomatous polyp and cancer can help to educate patients about the adenoma to carcinoma sequence and how this sequence can be interrupted with appropriate testing. The purpose of this study was to assess the use of a three-dimensional colon model with polyps and cancer provided to family physicians or nurses in some BLINDED family physician offices. Colon models were provided to 117 family medicine healthcare providers interested in colorectal cancer screening. Using a mailed survey and follow-up telephone calls to non-responders, 81 (69%) questionnaires were returned. Thirty-six (44%) of the respondents reported they had used the model, 33 (41%) reported they used the model for a mean 16% of their patients in a month's time, 31 (38%) reported using the model to teach patients about the colon and polyps prior to a colonoscopy. Other model use described by respondents included educating staff to promote patient willingness for colonoscopies, demonstrating the need for colon cancer screening, and teaching patients about annual fecal occult blood tests. Respondents agreed that anatomical models are helpful for patient education, the design of the colon model was good, and that it facilitated demonstration of colon polyps. Possible recommendations for an office-wide adoption of an anatomical model would be an in-service for all employees and a standard location for finding the model.

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

Cited by 49 publications

References 48 publications

System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy

Colon Polyp Model Use for Educating About Colorectal Cancer Screening in the Iowa Research Network

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