Nancy C Dolan1, Vanessa Ramirez-Zohfeld2, Alfred W Rademaker3,4, M Rosario Ferreira5, William L Galanter6, Jonathan Radosta6, Milton Mickey Eder7, Kenzie A Cameron2,3,4,8. 1. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA. ndolan@nmff.org. 2. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA. 3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, USA. 5. Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 6. Division of General Internal Medicine, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA. 7. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA. 8. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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.
RCT Entities:
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.
Entities:
Keywords:
colorectal cancer screening; health literacy; physician communication of preventive care; randomized trial
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