Susan M Rawl1, Shannon M Christy2, Susan M Perkins3, Yan Tong4, Connie Krier5, Hsiao-Lan Wang6, Amelia M Huang4, Esther Laury7, Broderick Rhyant4, Frank Lloyd4, Deanna R Willis4, Thomas F Imperiale8, Laura J Myers8, Jeffrey Springston9, Celette Sugg Skinner10, Victoria L Champion11. 1. Indiana University School of Nursing, Indianapolis, IN, United States of America; Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America. Electronic address: srawl@iu.edu. 2. Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America; Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America. 3. Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America; Indiana University School of Medicine, Indianapolis, IN, United States of America. 4. Indiana University School of Medicine, Indianapolis, IN, United States of America. 5. Indiana University School of Nursing, Indianapolis, IN, United States of America. 6. College of Nursing, University of South Florida, Tampa, FL, United States of America. 7. Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, PA, United States of America. 8. Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America. 9. Grady College of Journalism and Mass Communication, University of Georgia, Athens, Georgia. 10. University of Texas Southwestern Medical Center & Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, United States of America. 11. Indiana University School of Nursing, Indianapolis, IN, United States of America; Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, United States of America.
Abstract
INTRODUCTION: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. STUDY DESIGN/ PURPOSE: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. METHODS: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. RESULTS: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. CONCLUSION: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.
INTRODUCTION: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. STUDY DESIGN/ PURPOSE: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. METHODS: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. RESULTS: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. CONCLUSION: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.
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