Peter S Liang1, Chelle L Wheat2, Anshu Abhat3, Alison T Brenner4, Angela Fagerlin5,6, Rodney A Hayward5,6, Jennifer P Thomas7, Sandeep Vijan5,6, John M Inadomi1. 1. Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA. 2. Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA. 3. Department of Medicine, University of Washington, Seattle, Washington, USA. 4. Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 5. Veteran Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA. 6. Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA. 7. Department of Medicine, University of California, San Francisco, California, USA.
Abstract
OBJECTIVES: We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown. METHODS: In this trial, 997 participants were cluster randomized to one of the three screening strategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence. RESULTS: Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a non-nurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01). CONCLUSIONS: In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing.
RCT Entities:
OBJECTIVES: We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown. METHODS: In this trial, 997 participants were cluster randomized to one of the three screening strategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence. RESULTS:Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a non-nurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01). CONCLUSIONS: In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing.
Authors: Karen E Lasser; Jennifer Murillo; Sandra Lisboa; A Naomie Casimir; Lisa Valley-Shah; Karen M Emmons; Robert H Fletcher; John Z Ayanian Journal: Arch Intern Med Date: 2011-05-23
Authors: J D Hardcastle; J O Chamberlain; M H Robinson; S M Moss; S S Amar; T W Balfour; P D James; C M Mangham Journal: Lancet Date: 1996-11-30 Impact factor: 79.321
Authors: Aasma Shaukat; Steven J Mongin; Mindy S Geisser; Frank A Lederle; John H Bond; Jack S Mandel; Timothy R Church Journal: N Engl J Med Date: 2013-09-19 Impact factor: 91.245
Authors: Amy Duncan; Deborah Turnbull; Carlene Wilson; Joanne M Osborne; Stephen R Cole; Ingrid Flight; Graeme P Young Journal: BMC Public Health Date: 2014-03-07 Impact factor: 3.295
Authors: Channing E Tate; Daniel D Matlock; Alexandra F Dalton; Lisa M Schilling; Alexandra Marcus; Tiffany Schommer; Corey Lyon; Carmen L Lewis Journal: Jt Comm J Qual Patient Saf Date: 2018-04-25
Authors: Martin C S Wong; Jessica Y L Ching; Thomas Y T Lam; Simpson K C Ng; John C T Wong; Justin C Y Wu; Francis K L Chan Journal: JAMA Oncol Date: 2017-09-01 Impact factor: 31.777
Authors: Daniel S Reuland; Alison T Brenner; Richard Hoffman; Andrew McWilliams; Robert L Rhyne; Christina Getrich; Hazel Tapp; Mark A Weaver; Danelle Callan; Laura Cubillos; Brisa Urquieta de Hernandez; Michael P Pignone Journal: JAMA Intern Med Date: 2017-07-01 Impact factor: 21.873
Authors: Katherine Ni; Kelli O'Connell; Sanya Anand; Stephanie C Yakoubovitch; Simona C Kwon; Rabia Ali de Latour; Andrew B Wallach; Scott E Sherman; Mengmeng Du; Peter S Liang Journal: Cancer Prev Res (Phila) Date: 2020-02-03
Authors: Anne Marie Lennon; Adam H Buchanan; Isaac Kinde; Andrew Warren; Ashley Honushefsky; Ariella T Cohain; David H Ledbetter; Fred Sanfilippo; Kathleen Sheridan; Dillenia Rosica; Christian S Adonizio; Hee Jung Hwang; Kamel Lahouel; Joshua D Cohen; Christopher Douville; Aalpen A Patel; Leonardo N Hagmann; David D Rolston; Nirav Malani; Shibin Zhou; Chetan Bettegowda; David L Diehl; Bobbi Urban; Christopher D Still; Lisa Kann; Julie I Woods; Zachary M Salvati; Joseph Vadakara; Rosemary Leeming; Prianka Bhattacharya; Carroll Walter; Alex Parker; Christoph Lengauer; Alison Klein; Cristian Tomasetti; Elliot K Fishman; Ralph H Hruban; Kenneth W Kinzler; Bert Vogelstein; Nickolas Papadopoulos Journal: Science Date: 2020-04-28 Impact factor: 47.728
Authors: Caitlin C Murphy; Ahana Sen; Bianca Watson; Samir Gupta; Helen Mayo; Amit G Singal Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-11-18 Impact factor: 4.254
Authors: Amit G Singal; Samir Gupta; Celette Sugg Skinner; Chul Ahn; Noel O Santini; Deepak Agrawal; Christian A Mayorga; Caitlin Murphy; Jasmin A Tiro; Katharine McCallister; Joanne M Sanders; Wendy Pechero Bishop; Adam C Loewen; Ethan A Halm Journal: JAMA Date: 2017-09-05 Impact factor: 56.272