Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics

Evaluation of an Intervention to Increase Colorectal Cancer Screening in Primary Care Clinics

This study is a three-arm randomized controlled trial to implement and evaluate the relative effects of: 1) clinic-focused intervention; 2) combined patient- and clinic-focused intervention, and 3) usual care on the provision of colorectal cancer (CRC) screening in primary care clinics. The study will also examine the relative effects of the intervention conditions on secondary behavioral outcomes (e.g., clinician-patient discussions about CRC screening) and on intermediate outcome measures of attitudes, beliefs, opinions, and social influence surrounding CRC screening among patients, clinicians, and clinical staff. The target population includes average-risk patients aged 50-75 years, clinicians, and clinical staff within the primary care setting. The intervention will be implemented within primary care clinics in two managed care organizations (MCOs). The intervention targets the following CRC screening modalities: fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema.

Inclusion Criteria:

Inclusion Criteria for the Patient-focused Intervention

• Average risk
• Male or female
• 50-75 years
• Scheduled for non-acute ambulatory care visit at one of the study sites
• Due for CRC screening including no record of FOBT in the past year, no record of flexible sigmoidoscopy in the past 5 years, no record of colonoscopy in the past 10 years, and no record of double contrast barium enema in the past 5 years

Inclusion Criteria for the Clinic-focused Intervention

• Primary care clinicians, to include the following specialties: Family Practice/General Practice Physicians, General Internal Medicine Physicians, Nurse Practitioners in Family/General Practice, Physician Assistants who conduct non-acute ambulatory medical exams in study clinics
• Primary care clinical staff, to include nurses, medical assistants, and appointment schedulers

Exclusion Criteria (Patients):

• Prior diagnosis of CRC
• Prior diagnosis of colorectal polyps
• Prior diagnosis of ulcerative colitis
• Prior diagnosis of Crohn's Disease
• Prior diagnosis of hereditary nonpolyposis or polyposis
• Medical records contain an International Classification of Diseases (ICD-9) code for family history of CRC
• Younger than 50 years of age
• Older than 80 years of age.