Program to Improve Adherence to Colonoscopy: Interviews with Veterans (CDA 10-022)
Shahnaz Sultan MD MHS
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, FL
Funding Period: July 2012 - June 2016

BACKGROUND/RATIONALE:
CRC is the third leading cause of cancer-related deaths in the United States. Colonoscopy, an invasive test that allows for direct visualization of the colon, is the most commonly used test to screen for CRC and as a follow up test for abnormal results from non-invasive strategies for CRC screening. Non-adherence to colonoscopy (estimated to be 25% to 45%) represents a significant problem and contributes to CRC-related morbidity and mortality. The HSR&D study, "Program to Improve Adherence to Colonoscopy: Interviews with Veterans" (CDA 10-022), has the potential to improve adherence with the development of a multi-component intervention using peer coaches.

OBJECTIVE(S):
The objectives of this study are to: (a) identify barriers and facilitators of colonoscopy completion to inform the creation of a toolkit (b) develop and test a predictive model for adherence (c) design a peer coach training program (d) test the feasibility of using telephone-based peer coach phone interviews, and finally (d) perform a summative evaluation of the multi-component peer coach intervention.

METHODS:
To achieve these objectives, we are proposing a series of projects. We plan to conduct 8-10 focus groups (6-12 participants each) of adherent and non-adherent veterans to identify barriers and facilitators of colonoscopy completion. Findings from these focus groups will inform the development of a toolkit (Aim 1a). This toolkit will be field-tested and refined using additional focus groups (8 focus groups of 6-12) veterans and providers each (Aim 1b). All focus groups will be audiotaped, transcribed and analyzed using the constant comparative method of data analysis. Among veterans that have successfully completed a colonoscopy, we will identify, recruit, and train veterans as peer coaches and develop a formal peer coach training program (Aim 3). Two pilot studies will be conducted (Aim 3). We will recruit a random sample of 200 veterans scheduled for colonoscopy, administer a self-efficacy instrument and collect information on sociodemographic and health characteristics. Using multivariate logistic regression analysis, we will develop a prototype predictive model to identify veterans at high risk for non-adherence (pilot study #1). Additionally, we will test the feasibility of telephone-based peer coach interviews (1 week and 2 days prior to their procedure) in a random sample of 100 veterans scheduled for colonoscopy. The primary outcome (non-adherence), as well as patient satisfaction will be assessed. The final project is a formative evaluation of the peer coach intervention (including the dose, strength, and frequency of the intervention, utilization of materials, and feedback from the peer coach training program) to determine the success and feasibility of the peer coach intervention.

FINDINGS/RESULTS:
No preliminary findings yet.

IMPACT:
According to a 2007 directive, CRC screening is of high priority in the VA because of "the increasing demand for colonoscopy as the primary method for screening...and the cost of treatment for CRC." The aim of this CDA is to develop a multi-component peer coach intervention that will improve colonoscopy adherence. Adherence to colonoscopy (for screening and for diagnostic follow-up of abnormal findings) is a critical and necessary component of any programmatic effort to reduce CRC-related morbidity and mortality.

PUBLICATIONS:
None at this time.

DRA: Cancer
DRE: Diagnosis, Prevention
Keywords: Career Development
MeSH Terms: none