Journal of General Internal Medicine

, Volume 20, Issue 12, pp 1097–1101 | Cite as

Promoting use of colorectal cancer screening tests

Can we change physician behavior?
  • Judith M. E. Walsh
  • René Salazar
  • Jonathan P. Terdiman
  • Ginny Gildengorin
  • Eliseo J. Pérez-Stable
Original Articles

Abstract

BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality.

OBJECTIVE: To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening.

DESIGN: A randomized clinical trial of community physicians and their patients.

PARTICIPANTS: Ninety-four community primary care physicians randomly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group. Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician, a brochure on CRC screening, and a packet of fecal occult blood test (FOBT) cards.

MEASUREMENTS: After 1 year we measured receipt of the following: (1) FOBT in the past 2 years, (2) flexible sigmoidoscopy (SIG) or colonscopy (COL) in the previous 5 years, and (3) any CRC screening. We report the percent change from baseline in both groups.

RESULTS: 9,652 patients were enrolled for 2 years, and 3,732 patients were enrolled for 5 years. There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years (12.7 increase vs 12.5%, P=.51). Similar results were seen for any CRC screening among patients enrolled for 5 years (9.7% increase vs 8.6%, P=.45). The only outcome on which the intervention had an effect was on patient rates of screening SIG (7.4% increase vs 4.4%, P<.01).

CONCLUSION: With the exception of an increase in rates of SIG in the intervention group, the intervention had no effect on rates of CRC screening. Future interventions should assess innovative approaches to increase rates of CRC screening.

Key Words

colorectal cancer screening prevention 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kronborg O, Fenger C, Olsen J, Jorgensen O, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Hardcastle J, Chamberlain J, Robinson M, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Mandel J, Bond J, Church T, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Coffield AB, Maciosek MV, McGinnis JM, et al. Priorities among recommended clinical preventive services. Am J Prev Med. 2001;21:1–9.PubMedCrossRefGoogle Scholar
  5. 5.
    United States Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale. Ann Intern Med. 2002;137:129–31.Google Scholar
  6. 6.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology. 2003;124:544–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Rex D, Johnson D, Lieberman D, Burt R, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:868–77.PubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged ≥ 50Y—United States, 2001. MMWR. 2003;52:193–6.Google Scholar
  9. 9.
    Survey of physicians’ attitudes and practices in early cancer detection. CA Cancer J Clin. 1985;35:197–213.Google Scholar
  10. 10.
    Battista R. Adult cancer prevention in primary care: patterns of practice in Quebec. Am J Public Health. 1983;73:1036–9.PubMedGoogle Scholar
  11. 11.
    Carter W, Belcher D, Inui T. Implementing preventive care in clinical practice. II. Problems for managers, clinicians and patients. Med Care Rev. 1981;38:195–216.PubMedCrossRefGoogle Scholar
  12. 12.
    McPhee S, Richard R, Solkowitz S. Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society Guidelines. J Gen Intern Med. 1986;1:275–81.PubMedCrossRefGoogle Scholar
  13. 13.
    1989 survey of physicians’ attitudes and practices in early cancer detection. CA Cancer J Clin. 1990;40:77–101.Google Scholar
  14. 14.
    McDowell I, Newell C, Rosser N. Computerized reminders to encourage cervical screening in family practice. J Fam Pract. 1989;28:420–4.PubMedGoogle Scholar
  15. 15.
    Pierce M, Lundy S, Palanisamy A, Winning S, King J. Prospective randomised controlled trial of methods of call and recall for cervical cytology screening. BMJ. 1989;299:160–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Turner B, Day S, Borenstein B. A controlled trial to improve delivery of preventive care: physician or patient reminders? J Gen Intern Med. 1989;4:403–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Wolosin R. Effect of appointment scheduling and reminder postcards on adherence to mammography recommendations. J Fam Pract. 1990;30:542–7.PubMedGoogle Scholar
  18. 18.
    Petravage J, Swedberg J. Patient response to sigmoidoscopy recommendations via mailed reminders. J Fam Pract. 1988;27:387–9.PubMedGoogle Scholar
  19. 19.
    Walsh J, Kaplan C, Nguyen B, Gildengorin G, McPhee S, Perez-Stable E. Barriers to Colorectal Cancer Screening in Latino and Vietnamese Americans. J Gen Intern Med. 2004;19:156–66.PubMedCrossRefGoogle Scholar
  20. 20.
    Walsh J, McPhee S. A systems model of clinical preventive care: an analysis of factors influencing patient and physician. Health Educ Quarterly. 1992b;19:157–75.Google Scholar
  21. 21.
    Soumerai SB, Avorn J. Principles of educational outreach (“academic detailing”) to improve clinical decision making. JAMA. 1990;263:549–56.PubMedCrossRefGoogle Scholar
  22. 22.
    Imperiale T, Wagner D, Lin C, Larkin G, Rogge J, Ransohoff D. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Lieberman D, Weiss D, Bond J, Ahnen D, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.PubMedCrossRefGoogle Scholar
  24. 24.
    SAS Institute. SAS Online Doc®. Version 8. Cary, NC: SAS Institute, Inc.; 1999.Google Scholar
  25. 25.
    American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2001;51:87–8.Google Scholar
  26. 26.
    Cram P, Fendrick A, Inadomi J, Cowen M, Carpenter D, Vijan S. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med. 2003;163:1601–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Podolsky D. Going the distance—the case for true colorectal-cancer screening. N Engl J Med. 2000;343:207–8.PubMedCrossRefGoogle Scholar
  28. 28.
    DeLaet D, Shea S, Carrasquillo O. Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans. J Gen Intern Med. 2002;17:451–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Rizzo J. Are HMOs bad for health maintenance? Health Econ. 2005; in Press.Google Scholar
  30. 30.
    Greene J, Blustein J, Laflamme K. Use of preventive care services, beneficiary characteristics, and medicare HMO performance. Health Care Financing Rev. 2001;22:141–53.Google Scholar
  31. 31.
    Buchner D, Larson E, White R. Influenza vaccination in community elderly. A controlled trial of postcard reminders. J Am Geriatr Soc. 1987;35:755–60.PubMedGoogle Scholar
  32. 32.
    Zubarik R, Eisen G, Zubarik J, et al. Education improves colorectal cancer screening by flexible sigmoidoscopy in an inner city population. Am J Gastroenterol. 2000;95:509–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133:761–9.PubMedGoogle Scholar
  34. 34.
    Tilley B, Vernon S, Myers R, et al. The Next Step Trial: impact of a worksite colorectal cancer screening promotion program. Prev Med. 1999;28:276–83.PubMedCrossRefGoogle Scholar
  35. 35.
    Friedman L, Everett T, Peterson L, Ogbonnaya K, Mendizabal V. Compliance with fecal occult blood test screening among low-income medical outpatients: a randomized controlled trial using a videotaped intervention. J Cancer Educ. 2001;16:85–8.PubMedGoogle Scholar
  36. 36.
    Dolan J, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22:125–39.PubMedCrossRefGoogle Scholar
  37. 37.
    Wardle J, Williamson S, McCaffery K, et al. Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults. Health Psychol. 2003;22:99–105.PubMedCrossRefGoogle Scholar
  38. 38.
    Powe B. Promoting fecal occult blood testing in rural African American women. Cancer Pract. 2002;10:139–46.PubMedCrossRefGoogle Scholar
  39. 39.
    Zapka J, Lemon S, Puleo E, Estabrook B, Luckmann R, Erban S. Patient education for colon cancer screening: a randomized trial of a video mailed before a physical examination. Ann Intern Med. 2004;141:683–92.PubMedGoogle Scholar
  40. 40.
    Snell J, Buck E. Increasing cancer screening: a meta-analysis. Prev Med. 1996;25:702–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Judith M. E. Walsh
    • 1
  • René Salazar
    • 1
  • Jonathan P. Terdiman
    • 2
  • Ginny Gildengorin
    • 1
  • Eliseo J. Pérez-Stable
    • 1
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Division of Gastroenterology, Department of MedicineUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations