Dataset Information

Time to screening in the systems of support to increase colorectal cancer screening trial.

ABSTRACT: Understanding how interventions affect time to completion of colorectal cancer screening might assist in planning and delivering population-based screening interventions. The Systems of Support to Increase Colorectal Cancer Screening (SOS) study was conducted between 2008 and 2011 at 21 primary care medical centers in Western Washington. Participants in the study, ages 50 to 73 years, were eligible if they were enrolled in Group Health (Seattle, WA) and were due for colorectal cancer screening. Of note, 4,675 recruited participants were randomized to usual care or one of three interventions with incremental levels of systems of support for completion of colorectal cancer screening. We conducted time to screening analyses of the SOS data in years 1 and 2. We investigated whether these effects were time-varying. For year 1, the intervention effects on the time to completion of colorectal cancer screening were the strongest during the first two post-randomization months and then decreased, with no significant effect after the fifth month. For year 2, the intervention effects on the time to colorectal cancer screening increased from the first to the third month and then decreased, with no significant effect after the fifth month. Hence, each of the interventions to increase colorectal cancer screening had its greatest effect within the first 3 months after being offered to participants. Future studies should test whether booster interventions offered later could increase screening rate among those who remain unscreened. Additional research is needed to develop intervention strategies for colorectal cancer screening that focus on sustained behavior over time.

SUBMITTER: Wang CY

PROVIDER: S-EPMC4119537 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Time to screening in the systems of support to increase colorectal cancer screening trial.

Wang Ching-Yun CY de Dieu Tapsoba Jean J Anderson Melissa L ML Vernon Sally W SW Chubak Jessica J Fuller Sharon S Green Beverly B BB

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20140602 8

Understanding how interventions affect time to completion of colorectal cancer screening might assist in planning and delivering population-based screening interventions. The Systems of Support to Increase Colorectal Cancer Screening (SOS) study was conducted between 2008 and 2011 at 21 primary care medical centers in Western Washington. Participants in the study, ages 50 to 73 years, were eligible if they were enrolled in Group Health (Seattle, WA) and were due for colorectal cancer screening. ...[more]

PMID: 24891548

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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.

Project description:BackgroundScreening decreases colorectal cancer (CRC) incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals.ObjectiveTo determine whether interventions using electronic health records (EHRs), automated mailings, and stepped increases in support improve CRC screening adherence over 2 years.Design4-group, parallel-design, randomized, controlled comparative effectiveness trial with concealed allocation and blinded outcome assessments. (ClinicalTrials.gov: NCT00697047)Setting21 primary care medical centers.Patients4675 adults aged 50 to 73 years not current for CRC screening.InterventionUsual care, EHR-linked mailings ("automated"), automated plus telephone assistance ("assisted"), or automated and assisted plus nurse navigation to testing completion or refusal ("navigated"). Interventions were repeated in year 2.MeasurementsThe proportion of participants current for screening in both years, defined as colonoscopy or sigmoidoscopy (year 1) or fecal occult blood testing (FOBT) in year 1 and FOBT, colonoscopy, or sigmoidoscopy (year 2).ResultsCompared with those in the usual care group, participants in the intervention groups were more likely to be current for CRC screening for both years with significant increases by intensity (usual care, 26.3% [95% CI, 23.4% to 29.2%]; automated, 50.8% [CI, 47.3% to 54.4%]; assisted, 57.5% [CI, 54.5% to 60.6%]; and navigated, 64.7% [CI, 62.5% to 67.0%]; P < 0.001 for all pair-wise comparisons). Increases in screening were primarily due to increased uptake of FOBT being completed in both years (usual care, 3.9% [CI, 2.8% to 5.1%]; automated, 27.5% [CI, 24.9% to 30.0%]; assisted, 30.5% [CI, 27.9% to 33.2%]; and navigated, 35.8% [CI, 33.1% to 38.6%]).LimitationParticipants were required to provide verbal consent and were more likely to be white and to participate in other types of cancer screening, limiting generalizability.ConclusionCompared with usual care, a centralized, EHR-linked, mailed CRC screening program led to twice as many persons being current for screening over 2 years. Assisted and navigated interventions led to smaller but significant stepped increases compared with the automated intervention only. The rapid growth of EHRs provides opportunities for spreading this model broadly.

Project description:Importance:Colorectal cancer screening rates are suboptimal, particularly among sociodemographically disadvantaged groups. Objective:To examine whether guaranteed money or probabilistic lottery financial incentives conditional on completion of colorectal cancer screening increase screening uptake, particularly among groups with lower screening rates. Design, Setting, and Participants:This parallel, 3-arm randomized clinical trial was conducted from March 13, 2017, through April 12, 2018, at 21 medical centers in an integrated health care system in western Washington. A total of 838 age-eligible patients overdue for colorectal cancer screening who completed a questionnaire that confirmed eligibility and included sociodemographic and psychosocial questions were enrolled. Interventions:Interventions were (1) mail only (n = 284; up to 3 mailings that included information on the importance of colorectal cancer screening and screening test choices, a fecal immunochemical test [FIT], and a reminder letter if necessary), (2) mail and monetary (n = 270; mailings plus guaranteed $10 on screening completion), or (3) mail and lottery (n = 284; mailings plus a 1 in 10 chance of receiving $50 on screening completion). Main Outcomes and Measures:The primary outcome was completion of any colorectal cancer screening within 6 months of randomization. Secondary outcomes were FIT or colonoscopy completion within 6 months of randomization. Intervention effects were compared across sociodemographic subgroups and self-reported psychosocial measures. Results:A total of 838 participants (mean [SD] age, 59.7 [7.2] years; 546 [65.2%] female; 433 [52.2%] white race and 101 [12.1%] Hispanic ethnicity) were included in the study. Completion of any colorectal screening was not significantly higher for the mail and monetary group (207 of 270 [76.7%]) or the mail and lottery group (212 of 284 [74.6%]) than for the mail only group (203 of 284 [71.5%]) (P = .11). For FIT completion, interventions had a statistically significant effect (P = .04), with a net increase of 7.7% (95% CI, 0.3%-15.1%) in the mail and monetary group and 7.1% (95% CI, -0.2% to 14.3%) in the mail and lottery group compared with the mail only group. For patients with Medicaid insurance, the net increase compared with mail only in FIT completion for the mail and monetary or the mail and lottery group was 37.7% (95% CI, 11.0%-64.3%) (34.2% for the mail and monetary group and 40.4% for the mail and lottery group) compared with a net increase of only 5.6% (95% CI, -0.9% to 12.2%) among those not Medicaid insured (test for interaction P = .03). Conclusions and Relevance:Financial incentives increased FIT uptake but not overall colorectal cancer screening. Financial incentives may decrease screening disparities among some sociodemographically disadvantaged groups. Trial Registration:ClinicalTrials.gov identifier: NCT00697047.

Project description:BackgroundAsian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans.MethodsA cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months.ResultsAll 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes.ConclusionsA culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society.

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Time to screening in the systems of support to increase colorectal cancer screening trial.

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Time to screening in the systems of support to increase colorectal cancer screening trial.

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