Skip to main content
Top
Published in: Implementation Science 1/2008

Open Access 01-12-2008 | Research article

The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial

Authors: Carmen L Lewis, Alison T Brenner, Jennifer M Griffith, Michael P Pignone

Published in: Implementation Science | Issue 1/2008

Login to get access

Abstract

Background

We sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice.

Methods

We conducted a controlled trial comparing the proportion of intervention patients who received colon cancer screening with wait list controls at one practice site. The intervention was a mailed package that included a letter from their primary care physician, a colon cancer screening decision aid, and instructions for obtaining each screening test without an office visit so that patients could access screening tests directly. Major outcomes were screening test completion and cost per additional patient screened.

Results

In the intervention group, 15% (20/137) were screened versus 4% (4/100) in the control group (difference 11%; (95%; CI 3%;18% p = 0.01). The cost per additional patient screened was estimated to be $94.

Conclusion

A multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening.
Appendix
Available only for authorised users
Literature
2.
go back to reference Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996, 348 (9040): 1472-1477. 10.1016/S0140-6736(96)03386-7.CrossRefPubMed Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996, 348 (9040): 1472-1477. 10.1016/S0140-6736(96)03386-7.CrossRefPubMed
3.
go back to reference 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 (9040): 1467-1471. 10.1016/S0140-6736(96)03430-7.CrossRefPubMed 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 (9040): 1467-1471. 10.1016/S0140-6736(96)03430-7.CrossRefPubMed
4.
go back to reference Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000, 343 (22): 1603-1607. 10.1056/NEJM200011303432203.CrossRefPubMed Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM: The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000, 343 (22): 1603-1607. 10.1056/NEJM200011303432203.CrossRefPubMed
5.
go back to reference 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 (2): 132-141.CrossRefPubMed 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 (2): 132-141.CrossRefPubMed
6.
go back to reference CDC: Increased use of colorectal cancer tests--United States, 2002 and 2004. MMWR Morb Mortal Wkly Rep. 2006, 55 (11): 308-311. CDC: Increased use of colorectal cancer tests--United States, 2002 and 2004. MMWR Morb Mortal Wkly Rep. 2006, 55 (11): 308-311.
7.
go back to reference Stone EG, Morton SC, Hulscher ME, Maglione MA, Roth EA, Grimshaw JM, Mittman BS, Rubenstein LV, Rubenstein LZ, Shekelle PG: Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002, 136 (9): 641-651.CrossRefPubMed Stone EG, Morton SC, Hulscher ME, Maglione MA, Roth EA, Grimshaw JM, Mittman BS, Rubenstein LV, Rubenstein LZ, Shekelle PG: Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002, 136 (9): 641-651.CrossRefPubMed
8.
go back to reference Vernon SW: Participation in colorectal cancer screening: a review. J Natl Cancer Inst. 1997, 89 (19): 1406-1422. 10.1093/jnci/89.19.1406.CrossRefPubMed Vernon SW: Participation in colorectal cancer screening: a review. J Natl Cancer Inst. 1997, 89 (19): 1406-1422. 10.1093/jnci/89.19.1406.CrossRefPubMed
9.
go back to reference Dietrich AJ, O'Connor GT, Keller A, Carney PA, Levy D, Whaley FS: Cancer: improving early detection and prevention. A community practice randomised trial. Bmj. 1992, 304 (6828): 687-691.CrossRefPubMedPubMedCentral Dietrich AJ, O'Connor GT, Keller A, Carney PA, Levy D, Whaley FS: Cancer: improving early detection and prevention. A community practice randomised trial. Bmj. 1992, 304 (6828): 687-691.CrossRefPubMedPubMedCentral
10.
go back to reference McPhee SJ, Bird JA, Jenkins CN, Fordham D: Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med. 1989, 149 (8): 1866-1872. 10.1001/archinte.149.8.1866.CrossRefPubMed McPhee SJ, Bird JA, Jenkins CN, Fordham D: Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med. 1989, 149 (8): 1866-1872. 10.1001/archinte.149.8.1866.CrossRefPubMed
11.
go back to reference Pignone M, Harris R, Kinsinger L: Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000, 133 (10): 761-769.CrossRefPubMed Pignone M, Harris R, Kinsinger L: Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000, 133 (10): 761-769.CrossRefPubMed
12.
go back to reference Kim J, Whitney A, Hayter S, Lewis C, Campbell M, Sutherland L, Fowler B, Googe S, McCoy R, Pignone M: Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inform Decis Mak. 2005, 5: 36-10.1186/1472-6947-5-36.CrossRefPubMedPubMedCentral Kim J, Whitney A, Hayter S, Lewis C, Campbell M, Sutherland L, Fowler B, Googe S, McCoy R, Pignone M: Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inform Decis Mak. 2005, 5: 36-10.1186/1472-6947-5-36.CrossRefPubMedPubMedCentral
13.
go back to reference Zapka JG, Lemon SC, 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 (9): 683-692.CrossRefPubMed Zapka JG, Lemon SC, 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 (9): 683-692.CrossRefPubMed
14.
go back to reference Church TR, Yeazel MW, Jones RM, Kochevar LK, Watt GD, Mongin SJ, Cordes JE, Engelhard D: A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening. J Natl Cancer Inst. 2004, 96 (10): 770-780.CrossRefPubMed Church TR, Yeazel MW, Jones RM, Kochevar LK, Watt GD, Mongin SJ, Cordes JE, Engelhard D: A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening. J Natl Cancer Inst. 2004, 96 (10): 770-780.CrossRefPubMed
15.
go back to reference Walsh JM, Salazar R, Terdiman JP, Gildengorin G, Perez-Stable EJ: Promoting use of colorectal cancer screening tests. Can we change physician behavior?. J Gen Intern Med. 2005, 20 (12): 1097-1101. 10.1111/j.1525-1497.2005.0245.x.CrossRefPubMedPubMedCentral Walsh JM, Salazar R, Terdiman JP, Gildengorin G, Perez-Stable EJ: Promoting use of colorectal cancer screening tests. Can we change physician behavior?. J Gen Intern Med. 2005, 20 (12): 1097-1101. 10.1111/j.1525-1497.2005.0245.x.CrossRefPubMedPubMedCentral
16.
go back to reference Andersen MR, Urban N, Ramsey S, Briss PA: Examining the cost-effectiveness of cancer screening promotion. Cancer. 2004, 101 (5 Suppl): 1229-1238. 10.1002/cncr.20511.CrossRefPubMed Andersen MR, Urban N, Ramsey S, Briss PA: Examining the cost-effectiveness of cancer screening promotion. Cancer. 2004, 101 (5 Suppl): 1229-1238. 10.1002/cncr.20511.CrossRefPubMed
17.
go back to reference Wolf MS, Fitzner KA, Powell EF, McCaffrey KR, Pickard AS, McKoy JM, Lindenberg J, Schumock GT, Carson KR, Ferreira MR, Dolan NC, Bennett CL: Costs and cost effectiveness of a health care provider-directed intervention to promote colorectal cancer screening among Veterans. J Clin Oncol. 2005, 23 (34): 8877-8883. 10.1200/JCO.2005.02.6278.CrossRefPubMed Wolf MS, Fitzner KA, Powell EF, McCaffrey KR, Pickard AS, McKoy JM, Lindenberg J, Schumock GT, Carson KR, Ferreira MR, Dolan NC, Bennett CL: Costs and cost effectiveness of a health care provider-directed intervention to promote colorectal cancer screening among Veterans. J Clin Oncol. 2005, 23 (34): 8877-8883. 10.1200/JCO.2005.02.6278.CrossRefPubMed
18.
go back to reference Lynch FL, Whitlock EP, Valanis BG, Smith SK: Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services. Prev Med. 2004, 38 (4): 403-411. 10.1016/j.ypmed.2003.11.024.CrossRefPubMed Lynch FL, Whitlock EP, Valanis BG, Smith SK: Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services. Prev Med. 2004, 38 (4): 403-411. 10.1016/j.ypmed.2003.11.024.CrossRefPubMed
19.
go back to reference Fishman P, Taplin S, Meyer D, Barlow W: Cost-effectiveness of strategies to enhance mammography use. Eff Clin Pract. 2000, 3 (5): 213-220.PubMed Fishman P, Taplin S, Meyer D, Barlow W: Cost-effectiveness of strategies to enhance mammography use. Eff Clin Pract. 2000, 3 (5): 213-220.PubMed
20.
go back to reference Saywell RM, Champion VL, Skinner CS, McQuillen D, Martin D, Maraj M: Cost-effectiveness comparison of five interventions to increase mammography screening. Prev Med. 1999, 29 (5): 374-382. 10.1006/pmed.1999.0568.CrossRefPubMed Saywell RM, Champion VL, Skinner CS, McQuillen D, Martin D, Maraj M: Cost-effectiveness comparison of five interventions to increase mammography screening. Prev Med. 1999, 29 (5): 374-382. 10.1006/pmed.1999.0568.CrossRefPubMed
Metadata
Title
The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial
Authors
Carmen L Lewis
Alison T Brenner
Jennifer M Griffith
Michael P Pignone
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2008
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-3-32

Other articles of this Issue 1/2008

Implementation Science 1/2008 Go to the issue