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The immediate objective of this proposal is to assess the effectiveness of a multi-faceted intervention to improve patient-provider communication about colorectal cancer screening in improving patient adherence with colorectal cancer screening recommendations. This intervention consists of: (1) guiding the communication process through patient activation to initiate a colorectal cancer screening discussion; (2) optimizing communication content through the use of a prompt sheet; and (3) cueing the provider to assess patient perception of the communication. The long-term objective of our research program is to maximize colorectal cancer screening rates throughout the VA through widespread adoption of clinically feasible approaches to enhance patient-provider communication.
In the United States, colorectal cancer is the third most common cancer and the second leading cause of cancer mortality with over 56,000 deaths in 2004). Early detection through screening decreases the mortality associated with the disease. However, adherence with current screening recommendations is low. A survey of the general population indicates that only 53.1% of Americans, age 50 years and older for whom colorectal cancer screening is recommended, are up-to-date with this preventive service. While colorectal cancer screening rates with the VA Healthcare System (VHA) are better than in the general population (75% in Fiscal Year (FY) 2005), they are lower than performance rates for other types of cancer screening (e.g., mammography) in VHA. Further, numerous VA medical centers report colorectal cancer screening rates below the level considered satisfactory.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | Communication sheet |
|
| Control | Other | Standard of care brochures |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Communication | Behavioral | Communication sheet |
| |
| Standard of care |
| Measure | Description | Time Frame |
|---|---|---|
| Completion of Colorectal Cancer Screening Tests | A survey collected data on patient demographic characteristics, family history of colorectal cancer or polyp, and provider recommendation for colorectal cancer screening, if any. In addition, we asked patients whether colorectal cancer screening was discussed at the visit. If the response was yes, we then asked patients how satisfied they were with the PCP communication during the visit in general using a 5-point Likert scale to a number of items describing the communication. A medical record review was conducted to collect data on provider ordering and patient completion of the following colorectal cancer screening tests during the study period (i.e., 6 months from the time of the clinical encounter): fecal occult blood testing, sigmoidoscopy, or colonoscopy. | 6-12 months |
| Quality of Communication | Patient satisfaction with the discussion of Colorectal Cancer (CRC) screening with the primary care provider (PCP). | immediate after the patient visit |
| Communication Content | PCP Explains CRC screening to my satisfaction | immediately after the patient visit |
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Inclusion Criteria:
Provider Eligibility:
Patient Eligibility:
Primary care patients who are not "up-to-date" with colorectal cancer screening are the targeted population for study enrollment.
Up-to-date with colorectal cancer screening is defined as having completed one of the following:
Other patient eligibility criteria are:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Bruce S. Ling, MD MPH | VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jesse Brown VA Medical Center, Chicago, IL | Chicago | Illinois | 60612 | United States | ||
| VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18725829 | Result | Ling BS, Trauth JM, Fine MJ, Mor MK, Resnick A, Braddock CH, Bereknyei S, Weissfeld JL, Schoen RE, Ricci EM, Whittle J. Informed decision-making and colorectal cancer screening: is it occurring in primary care? Med Care. 2008 Sep;46(9 Suppl 1):S23-9. doi: 10.1097/MLR.0b013e31817dc496. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Intervention | Intervention arm- Prompting by prevention nurses and a communication sheet provided A prevention nurse addressed the process of communication by activating the patient to initiate and conduct a discussion on colorectal cancer screening at the clinical encounter with their PCP. The prevention nurse also provided a talking guide to the patient which was a double-sided single sheet that contained specific communication content pertinent to colorectal cancer screening that should be addressed with the PCP during the clinical encounter and included specific information on fecal occult blood testing and colonoscopy. The patient and PCP could determine the depth at which the communication occurred depending on factors such as time and competing clinical demands. Included in this talking guide were items designed to assist the PCP in assessing the patient's perception of the communication that occurred during the clinical encounter. |
| FG001 | Control | Usual care arm which consisted of standard of care brochures available clinically. No communication prompts or guides provided for those in Arm 2. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Intervention | Intervention arm- Prompting by prevention nurses and a communication sheet provided A prevention nurse addressed the process of communication by activating the patient to initiate and conduct a discussion on colorectal cancer screening at the clinical encounter with their PCP. The prevention nurse also provided a talking guide to the patient which was a double-sided single sheet that contained specific communication content pertinent to colorectal cancer screening that should be addressed with the PCP during the clinical encounter and included specific information on fecal occult blood testing and colonoscopy. The patient and PCP could determine the depth at which the communication occurred depending on factors such as time and competing clinical demands. Included in this talking guide were items designed to assist the PCP in assessing the patient's perception of the communication that occurred during the clinical encounter. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Completion of Colorectal Cancer Screening Tests | A survey collected data on patient demographic characteristics, family history of colorectal cancer or polyp, and provider recommendation for colorectal cancer screening, if any. In addition, we asked patients whether colorectal cancer screening was discussed at the visit. If the response was yes, we then asked patients how satisfied they were with the PCP communication during the visit in general using a 5-point Likert scale to a number of items describing the communication. A medical record review was conducted to collect data on provider ordering and patient completion of the following colorectal cancer screening tests during the study period (i.e., 6 months from the time of the clinical encounter): fecal occult blood testing, sigmoidoscopy, or colonoscopy. | Posted | Count of Participants | Participants | 6-12 months |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intervention | Intervention arm- Prompting by prevention nurses and a communication sheet provided A prevention nurse addressed the process of communication by activating the patient to initiate and conduct a discussion on colorectal cancer screening at the clinical encounter with their PCP. The prevention nurse also provided a talking guide to the patient which was a double-sided single sheet that contained specific communication content pertinent to colorectal cancer screening that should be addressed with the PCP during the clinical encounter and included specific information on fecal occult blood testing and colonoscopy. The patient and PCP could determine the depth at which the communication occurred depending on factors such as time and competing clinical demands. Included in this talking guide were items designed to assist the PCP in assessing the patient's perception of the communication that occurred during the clinical encounter. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Maria K. Mor | Center for Health Equity Research and Promotion (VAPHS) | (412) 360-2240 | maria.mor@va.gov |
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| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| D009369 | Neoplasms |
| D003142 | Communication |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
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| ID | Term |
|---|---|
| D059039 | Standard of Care |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
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| Behavioral |
Standard of care brochures |
|
| Pittsburgh |
| Pennsylvania |
| 15240 |
| United States |
| Michael E. DeBakey VA Medical Center, Houston, TX | Houston | Texas | 77030 | United States |
| BG001 | Control | Standard of care brochures Standard of care: Standard of care brochures |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Charlson Comorbidity Index | The Charlson Comorbidity Index is a measure of comorbid burden. The index is a weighted sum of the presence of up to 22 comorbid conditions, which are each provided a weight of 1, 2, 3, or 6 as originally derived based on the contribution of each comorbid condition to one-year mortality. A score of 0, indicates the absence of the measured comorbidities, and higher scores indicate a higher level of comorbid burden, with a higher predicted risk of death. | Count of Participants | Participants |
|
| Family History of Colorectal Cancer or Polyps | Count of Participants | Participants |
|
| Education | Count of Participants | Participants |
|
| Site | Count of Participants | Participants |
|
| OG001 | Control | Standard of care brochures Standard of care: Standard of care brochures |
|
|
|
| Primary | Quality of Communication | Patient satisfaction with the discussion of Colorectal Cancer (CRC) screening with the primary care provider (PCP). | Posted | Count of Participants | Participants | immediate after the patient visit |
|
|
|
| Primary | Communication Content | PCP Explains CRC screening to my satisfaction | Posted | Count of Participants | Participants | immediately after the patient visit |
|
|
|
| 1 |
| 190 |
| 0 |
| 190 |
| 0 |
| 190 |
| EG001 | Control | Usual care arm which consisted of standard of care brochures available clinically. No communication prompts or guides provided for those in Arm 2. | 1 | 264 | 0 | 264 | 0 | 264 |
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| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
| D001519 | Behavior |
| Missing/Unknown/No Discussion |
|
| Missing/Unknown/Did not Discuss |
|