Cancer Control Research
5R01CA069653-03
Zapka, Jane G.
INCREASING COLORECTAL CANCER SCREENING
AbstractAdenocarcinoma of the colon and rectum is a major cause of death from
cancer in the United States and most authorities now recommend that
persons over age 50 be offered screening for colorectal cancer (CRC)
because of recent evidence that screening is effective in reducing CRC
mortality. However, rates of patient adherence with screening
sigmoidoscopy recommendations are low and little research has been done
to explain this limited compliance or to identify methods for increasing
patient participation.
We propose a randomized trial to measure the efficacy of an educational
video in increasing compliance with flexible sigmoidoscopy screening
(primary trial outcome). Subjects are established primary care patients
who have a scheduled non-urgent appointment with their primary care
physician. A stratified sample (gender/age) of 600 people will be
randomized to the intervention or comparison condition. Intervention
subjects will be mailed a video cassette with accompanying written
brochure prior to their appointment. It will emphasize patient-centered
education and will utilize role models to discuss barriers and enhance
motivation. During their visit, patients in both study conditions will
receive a standardized recommendation on CRC and printed material from
the physician. The primary trial outcome is completion of the
recommended sigmoidoscopy. Secondary outcomes include initial
acceptance of the recommendation, and selected knowledge, attitude and
belief measures which are hypothesized to be influenced by the video.
Telephone interviews will be conducted at baseline (To), directly after
the appointment (T1), and within four months after the primary care
visit during which period a sigmoidoscopy could have been completed
(T2).
The content and format of the video will be informed by focus groups and
a random digit dial survey of a representative sample of Massachusetts
residents over age 50. The survey will identify knowledge levels,
beliefs, and attitudes about CRC and sigmoidoscopy; document rates of
CRC screening; and identify factors independently related to
sigmoidoscopy screening intention and behavior, including personal
predisposing factors and enabling and reinforcing health system factors
and other potential mediating factors.
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