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BACKGROUND/RATIONALE:
Colorectal cancer is a disease with significant associated mortality and morbidity. Screening for colorectal cancer has been shown beneficial in reducing mortality and decreasing the incidence of disease. However, adherence with current colorectal cancer screening recommendations is low. Within the VA, a significant number of veterans are not current with colorectal cancer screening. The VA has undergone an extensive re-organization in its health care delivery system and has adopted many system-level interventions directly impacting utilization of colorectal cancer screening. However, initial improvements have leveled off recently and a large number of veterans are still in need of being current with colorectal cancer screening. This highlights the need to adopt other interventions to augment the existing approaches to the delivery of colorectal cancer screening services in the VA. One area with little evaluation has been the patient-provider communication toward colorectal cancer screening. Recent work suggests that higher quality patient-provider communications (as perceived by patients) is associated with higher levels of colorectal cancer screening utilization. However, prior work by this research team suggests that communication content toward colorectal cancer screening between patients and providers is lacking. A multi-faceted communication intervention has been designed to significantly improve the communication process, content, and perception toward colorectal cancer screening. The intervention will be administered in a clinically feasible manner using a patient mailing and existing clinical personnel (i.e. prevention nurse).
OBJECTIVE(S):
In this intervention, we aim to: (1) enhance the process of communication through the activation of patients by having the prevention nurse encourage the patient to initiate a colorectal cancer screening discussion with their primary care provider, (2) optimize communication content through a prompt sheet provided to the patient which will serve as a talking guide for the discussion, and (3) provide cues to the provider via the prompt sheet to assist in assessing the patient's perception of communication.
METHODS:
This study will be conducted as a randomized controlled study at primary care clinics in three VA medical centers (10 providers and 15 patients/provider at each site for a total of 450 patients). The primary aim is to test whether the intervention has a significant effect on increasing colorectal cancer screening test utilization. The patients in the experimental group will be provided an information packet mailed to them prior to the targeted clinic visit, receive encouragement from existing clinic personnel (i.e. prevention nurse) at the targeted visit to initiate a colorectal cancer screening discussion, and be given a prompt sheet which serves as a talking guide to be used with their primary care provider at the visit. The control group will receive the information packet only and otherwise not be exposed to any additional services beyond usual care. The clinic encounter will be audiotaped and the medical record reviewed 6 months after the administration of the intervention to evaluate for patient completion of colorectal cancer screening. An analysis of the audiotaped data will assess whether the intervention affected the quality of patient-provider communication as well to test whether the quality of communication has an effect on patient utilization of colorectal cancer screening tests
FINDINGS/RESULTS:
Currently in the recruitment phase. Preliminary analyses about to commence.
IMPACT:
Impact: If the intervention is effective with increasing colorectal cancer screening, future efforts will be directed at widespread implementation throughout the VA in a clinically feasible manner to maximize utilization of colorectal cancer screening among veterans. We will work with the Implementation Core at the VA CHERP to maximize the impact of this work.
(pending results of preliminary analyses)
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Prevention, Quality of Care
Keywords:
Cancer, Screening, Utilization patterns
MeSH Terms:
none
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