The Efficacy of Tailored Print Materials in Promoting Colorectal Cancer Screening: Results From a Randomized Trial Involving Callers to the National Cancer Institute's Cancer Information Service

Abstract

In this large randomized trial among callers to the Cancer Information Service (CIS), tailored print materials were tested for efficacy in promoting colorectal cancer (CRC) screening (fecal occult blood test [FOBT], flexible sigmoidoscopy, or colonoscopy). All participants completed baseline interviews at the end of their usual service calls to the CIS, as well as short-term (6-month) and longer-term (14-month) telephone follow-up interviews. The study sample (n = 4,014) was restricted to English-speaking CIS callers 50 + years of age, who would be eligible for CRC screening at 14 months follow-up and did not call the CIS about CRC or CRC screening. Four experimental conditions were compared: a single untailored (SU) mailout of print material (the control condition); a single tailored (ST) mailout of print material; four (multiple) tailored (MT) mailouts of print materials spanning 12 months, all of which were tailored to information obtained at baseline; and four (multiple) retailored (MRT) mailouts also spanning 12 months, with retailoring of the print materials (mailouts 2, 3, and 4) based on updated information obtained from the 6-month follow-up interviews. Consistent with the main hypothesis of this trial, a significant linear trend across the SU, ST, MT, and MRT groups was found at 14 months (42%, 44%, 51%, and 48%, respectively, p = 0.05). Only for MT was there a significant difference compared with SU (p = 0.03) for the sample as a whole, while no differences were found for MT vs. MRT at 14 months. Significant moderator effects in the predicted direction were found among females, younger participants, and among those with a history of CRC screening, all of which involved the SU vs. MT MRT comparisons. Only among younger participants (ages 50-59) was there a difference between SU vs. ST at 14 months. Given these results, we conclude from this trial the following: (1) the MRT intervention failed to show added benefit beyond the MT intervention, (2) the significant intervention effects involving the MT and MRT conditions can be explained by tailoring and/or the longitudinal nature of both interventions, and (3) the most compelling evidence in support of tailoring was found for the ST condition among younger participants, where a significant need for interventions exists at the national level. Directions for future research are discussed in light of the results summarized above.

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...…”

Recruiting Low-Income Healthy Women to Research: An Exploratory Study

“…The research protocol was approved by the institutional review boards at both the University of California, San Francisco and the Northern California Cancer Center. Similar research using telephone lines to implement various types of health interventions has been performed in diverse settings for non-minority populations (Darrow et al 1998;Davis et al 2004;Heimendinger et al 2005;Marcus et al 2005;Miller et al 2005;Strecher et al 2005).…”

A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives

“…Marcus and colleagues conducted one of the few randomized trials to examine the efficacy of tailored print materials to promote CRC screening among callers to the Cancer Information Service [16]. These investigators used a 4-group design and enrolled more than 4000 callers to the Cancer Information Service to test the effects of tailoring, multiple mailouts, and retailoring of print materials.…”