Dataset Information

Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.

ABSTRACT:

Background

Screening decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Screening breakdowns arise from lack of uptake and failure to follow-up after a positive screening test.

Objectives

Systems of support to increase colorectal cancer screening and follow-up (SOS) is a randomized trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design.

Methods

The setting is a large nonprofit healthcare organization. In part-1 study, patients age 50-75 due for CRC screening are randomized to one of 4 study conditions. Arm 1 receives usual care. Arm 2 receives automated support (mailed information about screening choices and fecal occult blood tests (FOBT)). Arm 3 receives automated and assisted support (a medical assistant telephone call). Arm 4 receives automated, assisted, and care management support (a registered nurse provides behavioral activation and coordination of care). In part-2, study patients with a positive FOBT or adenomas on flexible sigmoidoscopy are randomized to receive either usual care or nurse care management. Primary outcomes are: 1) the proportion with CRC screening, 2) the proportion with a complete diagnostic evaluation after a positive screening test.

Results

We sent recruitment letters to 15,414 patients and 4675 were randomized. Randomly assigned treatment groups were similar in age, sex, race, education, self-reported health, and CRC screening history.

Conclusions

We will determine the effectiveness and cost effectiveness of stepped increases in systems of support to increase CRC screening and follow-up after a positive screening test over 2years.

SUBMITTER: Green BB

PROVIDER: S-EPMC2956868 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

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Publications

Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.

Green Beverly B BB Wang C Y CY Horner Kathryn K Catz Sheryl S Meenan Richard T RT Vernon Sally W SW Carrell David D Chubak Jessica J Ko Cynthia C Laing Sharon S Bogart Andy A

Contemporary clinical trials 20100730 6

<h4>Background</h4>Screening decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Screening breakdowns arise from lack of uptake and failure to follow-up after a positive screening test.<h4>Objectives</h4>Systems of support to increase colorectal cancer screening and follow-up (SOS) is a randomized trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design ...[more]

PMID: 20674774

Similar Datasets

Project description:Background/Aims Screening decreases colorectal cancer (CRC) incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals. Our objective was to determine whether interventions using electronic health records, automated mailings, and stepped increases in support increased being current for CRC testing over 2 years. Methods Setting and participants: SOS was a four-arm parallel design randomized controlled comparative effectiveness trial with concealed allocation and blinded outcome assessments (ClinicalTrials.gov registration number: NCT00697047). Patients aged 50–73 at baseline (n = 4674) not current for CRC screening and with no life-threatening illnesses from 21 primary care medical centers were randomized. Interventions: Usual care (UC), Automated mailed (Automated), Automated plus medical assistant telephone assistance (Assisted), or both Automated and Assisted interventions plus nurse navigation until testing was completed or declined (Navigated). Interventions were repeated in year 2. Measurements: Primary outcomes were the proportion current for screening in both years, defined as completion of a colonoscopy or sigmoidoscopy in year 1, or fecal occult blood test (FOBT) in year 1 and either FOBT, colonoscopy, or sigmoidoscopy in year 2. Results Compared to UC, intervention patients were more likely to be current for CRC screening for both years of the study, with incremental increases by intervention intensity (UC 26.5% vs. Automated 50.7%, Assisted 57.7%, or Navigated 64.4% P <.001). Automated interventions increased CRC screening in all patient subgroups compared to UC. The higher-intensity Assisted and Navigated interventions were less effective in patients age ?65, and African American/Blacks and those reporting mixed race. Two-year intervention cost estimates were $57,000 for Automated, $67,000 for Assisted, and $79,000 for Navigated. Inclusion of CRC test costs produced total intervention costs of $314,000, $342,000, and $390,000 for three arms respectively, compared to $339,000 for UC costs for CRC tests alone. Conclusions A low-cost stepped intervention that leveraged automated data and centralized processes led to twice as many people being current for CRC screening over 2 years. The rapid growth of electronic health records provides opportunities for spreading this model broadly.

Dataset Information

Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.

Background

Objectives

Methods

Results

Conclusions

Publications

Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.

Similar Datasets

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