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

Abstract

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.

Colorectal Cancer Screening in Vulnerable Patients

“…30–33 However, no prior studies were found that have demonstrated that a CRC screening decision aid or educational video meaningfully increases discussion of more than one screening test option (a proxy for shared decision making). 34 Further, although a few CRC decision aid studies have enrolled diverse, vulnerable patient populations, 33,35 there is a need to identify screening interventions that are effective in Latino populations, who have substantially lower screening rates than the general U.S. population. 36 However, no U.S. clinical trials of CRC screening decision aids conducted in Spanish-speaking populations were found.…”

Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations

“…Budget constraints and time pressures were also reported as barriers to longer training; it is unrealistic for busy clinicians to attend even a 1-day training [7,15,46] . In the remaining articles, four add-on session types were identified: supervision n = 5 [3, 4*, 8*, 37*, 44*] , coaching n = 4 [27, 28*, 40*, 48*] , booster n = 2 [18,31] and telephone calls n = 3 [5*, 11, 31] . 4.…”

“…Three articles offered no information on role-play [18,24,25] , but all others mentioned using role-play as an experiential learning technique either with n = 33 [1, 2, 6, 8*, 9-16, 19*, 20*, 21-23, 26*, 27, 29, 30, 32-34, 36, 38, 39, 40*, 41, 42, 43*, 48*, 49] or without n = 13 [3, 4*, 5*, 7, 17, 28*, 31, 35*, 37*, 44*, 45-47] specified feedback from facilitators, other participants and/or simulated patients. Three articles offered no information on role-play [18,24,25] , but all others mentioned using role-play as an experiential learning technique either with n = 33 [1, 2, 6, 8*, 9-16, 19*, 20*, 21-23, 26*, 27, 29, 30, 32-34, 36, 38, 39, 40*, 41, 42, 43*, 48*, 49] or without n = 13 [3, 4*, 5*, 7, 17, 28*, 31, 35*, 37*, 44*, 45-47] specified feedback from facilitators, other participants and/or simulated patients.…”

“…While almost one-fifth of the included articles n = 9 [1,6,7,13,14,24,25,33,38] provided no information on supervision or booster sessions, most indicated that their CST programmes were not supplemented by supervision or booster sessions n = 27 [2, 9, 10, 12, 15-17, 19*, 20*, 21-23, 26*, 29, 30, 32, 34, 35*, 36, 39, 41, 42, 43*, 45-47, 49] . In the remaining articles, four add-on session types were identified: supervision n = 5 [3, 4*, 8*, 37*, 44*] , coaching n = 4 [27, 28*, 40*, 48*] , booster n = 2 [18,31] and telephone calls n = 3 [5*, 11, 31] . "Coaching sessions" were typically defined as: a 30-min session in the everyday routine approximately 2 weeks after CST to individualise the training [27] ; 4 30-min individual coaching appointments focused on positive reinforcement and self-reflection, selected video sequences, behavioural analyses for developing alternative behaviour, identifying solutions for difficult patient conversations [40] ; and a 30-min personal coaching session 2 weeks after CST to transfer individual learning goals into routine consultations [28] .…”

Capsule Commentary on Dolan et al., The Effectiveness of a Physician-Only and Physician-Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

“…2 The 'waiting room video' is an attractive way to use patient downtime before an appointment, and is available in both English and Spanish. Providing information directly to patients matches the intent of the Ecological Model for Ambulatory Patient Safety in Chronic Disease to produce collaboration between an activated patient and a proactive practice team.…”