Combined Patient and Physician Intervention To Increase Colorectal Cancer Screening

Ferreira MR, Gorby NS, Dolan N. Combined Patient and Physician Intervention To Increase Colorectal Cancer Screening. Paper presented at: Digestive Disease Week Annual Conference; 2004 May 1; New Orleans, LA.

Purpose: To determine whether a combined patient and physician intervention increases colorectal cancer screening recommendations and adherence.Methods: Randomized controlled intervention at two general medicine outpatient firms, at a Veterans Administration Medical Center. One firm was randomly assigned to the combined intervention and the other to usual care. The patient component of the intervention included an educational video and brochure. The physician component included an educational workshop and quarterly sessions with feedback on physician screening recommendations and patient adherence. Subjects were males, 50 years old and older, who had not received colorectal cancer screening, and who were at average risk for colorectal cancer. The main study outcomes were colorectal cancer screening recommendations by physicians and patient adherence to colorectal cancer screening, as documented in the patient medical records.Results: There were 979 eligible patients in the intervention firm and 941 eligible patients in the usual care firm. Patient mean age was 67.8 years, 44% of patients were white and 50% were African-American, with no significant difference between the firms. After 6-12 months of follow-up 76% of patients in the intervention arm received a screening recommendation from their physicians, compared to 70% in the usual care arm (p = 0.038, adjusted for clustering by physician). After 6-12 months of follow-up 41% of patients in the intervention arm completed colorectal cancer screening, compared to 33% in the usual care arm (p = 0.008, adjusted for clustering by physician). In the intervention arm only 197 patients received the patient component of the intervention, in addition to the physician component, and in this group 46% of 197 patients completed a screening test (p = 0.004, compared to 33% in the usual care arm, adjusted for clustering by physician). Among the 782 patients in the intervention arm that received only the physician component, only 40% completed screening (p = 0.028, compared to 33% in the usual care arm, adjusted for clustering by physician).Conclusions: Our combined patient and physician intervention significantly increased physician recommendations and patient adherence to colorectal cancer screening among Veterans. Our results also indicate that the combined patient and physician intervention resulted in a larger proportion of patients completing screening compared to the physician component of the intervention alone.