Journal of General Internal Medicine

, Volume 20, Issue 3, pp 278–282 | Cite as

Randomized controlled trial of the impact of intensive patient education on compliance with fecal occult blood testing

  • Charlene L. Stokamer
  • Craig T. Tenner
  • Jhuma Chaudhuri
  • Eva Vazquez
  • Edmund J. Bini
Original Articles


BACKGROUND: Randomized controlled trials have demonstrated that fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality. However, patient compliance with FOBT is low and this is one of the major barriers to CRC screening.

OBJECTIVE: To determine whether intensive patient education increases FOBT card return rates.

DESIGN: Randomized controlled trial.

SETTING: Department of Veterans Affairs primary care clinic.

PARTICIPANTS: Seven hundred eighty-eight patients who were referred for FOBT.

INTERVENTIONS: Patients were randomly allocated to receive either intensive (n=396) or standard (n=392) patient education. Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening, were instructed on how to properly collect stool specimens for FOBT, and were given a 2-page handout on CRC screening. Patients in the standard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT.

RESULTS: Patients in the intensive education group were more likely to return the FOBT cards (65.9% vs 51.3%; P<.001) and called the clinic with additional questions less often (1.5% vs 5.9%; P=.001) than the standard education group. The median time to return the FOBT cards was significantly shorter in the intensive education group (36 vs 143 days; P<.001 by log-rank test). However, the proportion of patients who had a positive FOBT did not differ in the two groups (4.6% vs 6.0%; P=.51).

CONCLUSIONS: Intensive patient education significantly improved patient compliance with FOBT. Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted.

Key words

randomized controlled trial colon cancer screening fecal occult blood testing primary care patient education 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004;54:8–29.PubMedGoogle Scholar
  2. 2.
    Mandel JS, Bond JH, Church TR, 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
  3. 3.
    Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:132–41.PubMedGoogle Scholar
  6. 6.
    Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2004. CA Cancer J Clin. 2004;54:41–52.PubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol. 2003;95:868–77.Google Scholar
  9. 9.
    American Society for Gastrointestinal Endoscopy. Guidelines for colorectal cancer screening and surveillance. Gastrointest Endosc. 2000;51:777–82.CrossRefGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged >or=50 years—United States, 2001. MMWR Morb Mortal Wkly Rep. 2003;52:193–6.Google Scholar
  11. 11.
    U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office; November 2000.Google Scholar
  12. 12.
    Knight KK, Fielding JE, Battista RN. U.S. Preventive Services. Task Force Occult blood screening for colorectal cancer. JAMA. 1989;261:586–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Ahlquist DA. Occult blood screening. Obstacles to effectiveness. Cancer. 1992;70:1259–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Wender RC. Barriers to screening for colorectal cancer. Gastrointest Endosc Clin N Am. 2002;12:145–70.PubMedCrossRefGoogle Scholar
  15. 15.
    Sharma VK, Vasudeva R, Howden CW. Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey. Am J Gastroenterol. 2000;95:1551–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Vernon SW. Participation in colorectal cancer screening: a review. J Natl Cancer Inst. 1997;89:1406–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRefGoogle Scholar
  18. 18.
    Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11:1–47.PubMedGoogle Scholar
  19. 19.
    Powe BD. Perceptions of cancer fatalism among African Americans: the influence of education, income, and cancer knowledge. J Natl Black Nurses Assoc. 1994;7:41–8.PubMedGoogle Scholar
  20. 20.
    DiPalma AM, Barnes SE, DiPalma JA. Patient participation in colon cancer screening programs. South Med J. 1998;91:342–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Weitzman ER, Zapka J, Estabrook B, Goins KV. Risk and reluctance: understanding impediments to colorectal cancer screening. Prev Med. 2001;32:502–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Brouse CH, Basch CE, Wolf RL, Shmukler C, Neugut AI, Shea S. Barriers to colorectal cancer screening with fecal occult blood testing in a predominantly minority urban population: a qualitative study. Am J Public Health. 2003;93:1268–71.PubMedGoogle Scholar
  23. 23.
    Sterchi JM. Screening for colorectal cancer. South Med J. 1979;72:1144–6.PubMedGoogle Scholar
  24. 24.
    Winchester DP, Shull JH, Scanlon EF, et al. A mass screening program for colorectal cancer using chemical testing for occult blood in the stool. Cancer. 1980;45:2955–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Trehu EG, Cooper JN. Cost of screening for colorectal cancer: results of a community mass screening program and review of the literature. South Med J. 1992;85:248–54.PubMedGoogle Scholar
  26. 26.
    Khubchandani IT, Karamchandani MC, Kleckner FS, et al. Mass screening for colorectal cancer. Dis Colon Rectum. 1989;32:754–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Grazzini G, Castiglione G, Isu A, et al. Colorectal cancer screening by fecal occult blood testing: results of a population-based experience. Tumori. 2000;86:384–8.PubMedGoogle Scholar
  28. 28.
    Ko CW, Dominitz JA, Nguyen TD. Fecal occult blood testing in a general medical clinic: comparison between guaiac-based and immunochemical-based tests. Am J Med. 2003;115:111–4.PubMedCrossRefGoogle Scholar
  29. 29.
    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
  30. 30.
    Weinrich SP, Weinrich MC, Boyd MD, Atwood J, Cervenka B. Teaching older adults by adapting for aging changes. Cancer Nurs. 1994;17:494–500.PubMedCrossRefGoogle Scholar
  31. 31.
    Meade CD, McKinney WP, Barnas GP. Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer. Am J Public Health. 1994;84:119–21.PubMedCrossRefGoogle Scholar
  32. 32.
    Hart AR, Barone TL, Mayberry JF. Increasing compliance with colorectal cancer screening: the development of effective health education. Health Educ Res. 1997;12:171–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Myers RE, Balshem AM, Wolf TA, Ross EA, Millner L. Adherence to continuous screening for colorectal neoplasia. Med Care. 1993;31:508–19.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Charlene L. Stokamer
    • 1
  • Craig T. Tenner
    • 2
    • 4
  • Jhuma Chaudhuri
    • 4
  • Eva Vazquez
    • 1
  • Edmund J. Bini
    • 3
    • 4
  1. 1.Department of Patient Services/NursingNew York University School of MedicineNew YorkUSA
  2. 2.Department of MedicineNew York University School of MedicineNew YorkUSA
  3. 3.New York Harbor Healthcare System, Division of Gastroenterology (111D)New York
  4. 4.New York University School of MedicineNew YorkUSA

Personalised recommendations