Systematic Review: Enhancing the Use and Quality of Colorectal Cancer Screening

University of North Carolina at Chapel Hill, North Carolina, United States
Annals of internal medicine (Impact Factor: 17.81). 04/2010; 152(10):668-76. DOI: 10.1059/0003-4819-152-10-201005180-00239
Source: PubMed


National guideline groups recommend screening and discussion of screening options for persons at average risk for colorectal cancer (CRC). However, emerging evidence suggests that CRC screening is simultaneously underused, overused, and misused and that adequate patient-provider discussions about screening are infrequent.
To summarize evidence on factors that influence CRC screening and strategies that increase the appropriate use and quality of CRC screening and CRC screening discussions.
MEDLINE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials were searched for English-language publications describing studies conducted in the United States from January 1998 through September 2009.
Two reviewers independently selected studies that addressed the study questions and met eligibility criteria.
Information on study design, setting, intervention, outcomes, and quality were extracted by one reviewer and double-checked by another. Reviewers assigned a strength-of-evidence grade for intervention categories by using criteria plus a consensus process.
Reviewers found evidence of simultaneous underuse, overuse, and misuse of CRC screening as well as inadequate clinical discussions about CRC screening. Several patient-level factors were independently associated with lower screening rates, including having low income or less education, being uninsured, being Hispanic or Asian, being less acculturated into the United States, or having limited access to care. Evidence that interventions that included patient reminders or one-on-one interactions (that is, between patients and nonphysician clinic staff), eliminated structural barriers (for example, simplifying access to fecal occult blood test cards), or made system-level changes (for example, using systematic screening as opposed to opportunistic screening) were effective in enhancing use of CRC screening was strong. Evidence on how best to enhance discussions about CRC screening options is limited. No studies focused on reducing overuse, and very few focused on misuse.
Reporting and publication bias may have affected our findings. The independent effect of individual elements of multicomponent interventions was often uncertain.
Although CRC screening is underused overall, important problems of overuse and misuse also exist. System- and policy-level interventions that target vulnerable populations are needed to reduce underuse. Interventions aimed at reducing barriers by making the screening process easier are likely to be effective. Studies aimed at reducing overuse and misuse and at enhancing the quality and frequency of discussions about CRC screening options are needed.
Agency for Healthcare Research and Quality.

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    • "Le média favoriserait qui plus est à lui seul l'adhérence au dépistage des cancers (Saywell et al., 2004). Il permettrait en outre d'établir un choix informé ou un appel à la peur individualisé qui tiennent plus facilement compte au contact du bénéficiaire de sa subjectivité (Holden, Jonas, Porterfield, Reuland & Harris, 2010) et de ses motivations (Wahab, Menon & Szalacha, 2008). Des recherches appliquées au dépistage organisé du cancer colorectal montrent ainsi des effets positifs sur la participation (Menon et al., 2011 ;Wahab et al., 2008). "
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    ABSTRACT: The participation to colorectal cancer screening program determines the efficiency and costeffectiveness of the program. However, participation rates do not reach the expectations and decrease continuously. The goal of the present research was to test the efficiency of different communication strategies used to encourage eligible targets to colorectal cancer screening. The present study is a randomized controlled study conducted on 50 to 52 years old individuals. Two communications strategies were compared. The first was based on informed choice and exposed the pros and cons of screening. The second was based on the fear appeals. Three letters (informed choice, fear appeal and control letters) were conceived and sent to 8660 individuals who were eligible to a first time screening test. A phone interview was conducted with 40 individuals who did not receive screening, in order to measure their attitudes concerning the mail. Results indicated, first, that 25,90% of the subjects had read the mail inviting them to the screening test, and 13.70% were really screened. The three letters generated the same detection rate. However, the informed choice improved the quality of the information about the risks of the screening and aroused a bigger concern to be detected that the other mails. Results are discussed in light of the psychological models of prevention in term of health behaviors. The relevance of campaigns based on direct mailing is discussed in reference to the recent works in marketing.
    No preview · Article · Dec 2015 · Revue Internationale de Psychologie Sociale
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    • "To meet this challenge, tailored methods such as phone call interventions are being developed in addition to the standard postal approach. Phone calls are reportedly more effective (Rimer & Lipscomb, 2000) and cost-effective (Majowicz et al., 2004) than letters owing to the direct verbal exchange between the healthcare professional and the beneficiary (Holden et al., 2010). Indeed, it is thought that tailored phone counseling is two-fold more efficient than standard mailing (Prochaska et al., 2001). "
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    ABSTRACT: Introduction. – While high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation. Objective. – This randomized controlled study aimed to testthe impact ofindividualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test. Method. – Two phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups. Results. – A simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates. Conclusion. – The results are discussed for future research
    Full-text · Article · May 2015 · Revue Européenne de Psychologie Appliquée
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    • "Despite increases in screening rates in the last decade [5], only 65% of US adults are up to date with recommended screening, and only about 47% of US Latino adults [6,7]. Members of vulnerable groups, including racial or ethnic minorities, the uninsured, and Medicaid populations have the lowest screening rates in the USA [8]. The many patient-, provider-, and system-level barriers that inhibit the CRC screening process disproportionately affect vulnerable groups. "
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    ABSTRACT: Background Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients. Methods/Design We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on CRC screening. Discussion This pragmatic randomized controlled trial will test a combined decision aid and patient navigator intervention targeting CRC screening completion. Findings from this trial may inform future interventions and implementation policies designed to promote CRC screening in vulnerable patient populations and to reduce screening disparities. Clinical trial registration NCT02054598.
    Full-text · Article · Jul 2014 · Trials
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