Skip to main content
SpringerLink
Log in

Promoting use of colorectal cancer screening tests

Can we change physician behavior?

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality.

OBJECTIVE: To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening.

DESIGN: A randomized clinical trial of community physicians and their patients.

PARTICIPANTS: Ninety-four community primary care physicians randomly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group. Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician, a brochure on CRC screening, and a packet of fecal occult blood test (FOBT) cards.

MEASUREMENTS: After 1 year we measured receipt of the following: (1) FOBT in the past 2 years, (2) flexible sigmoidoscopy (SIG) or colonscopy (COL) in the previous 5 years, and (3) any CRC screening. We report the percent change from baseline in both groups.

RESULTS: 9,652 patients were enrolled for 2 years, and 3,732 patients were enrolled for 5 years. There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years (12.7 increase vs 12.5%, P=.51). Similar results were seen for any CRC screening among patients enrolled for 5 years (9.7% increase vs 8.6%, P=.45). The only outcome on which the intervention had an effect was on patient rates of screening SIG (7.4% increase vs 4.4%, P<.01).

CONCLUSION: With the exception of an increase in rates of SIG in the intervention group, the intervention had no effect on rates of CRC screening. Future interventions should assess innovative approaches to increase rates of CRC screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kronborg O, Fenger C, Olsen J, Jorgensen O, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.

    Article  PubMed  CAS  Google Scholar 

  2. Hardcastle J, Chamberlain J, Robinson M, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.

    Article  PubMed  CAS  Google Scholar 

  3. Mandel J, Bond J, Church T, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–71.

    Article  PubMed  CAS  Google Scholar 

  4. Coffield AB, Maciosek MV, McGinnis JM, et al. Priorities among recommended clinical preventive services. Am J Prev Med. 2001;21:1–9.

    Article  PubMed  CAS  Google Scholar 

  5. United States Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale. Ann Intern Med. 2002;137:129–31.

    Google Scholar 

  6. Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology. 2003;124:544–60.

    Article  PubMed  Google Scholar 

  7. Rex D, Johnson D, Lieberman D, Burt R, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:868–77.

    PubMed  CAS  Google Scholar 

  8. Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged ≥ 50Y—United States, 2001. MMWR. 2003;52:193–6.

    Google Scholar 

  9. Survey of physicians’ attitudes and practices in early cancer detection. CA Cancer J Clin. 1985;35:197–213.

    Google Scholar 

  10. Battista R. Adult cancer prevention in primary care: patterns of practice in Quebec. Am J Public Health. 1983;73:1036–9.

    PubMed  CAS  Google Scholar 

  11. Carter W, Belcher D, Inui T. Implementing preventive care in clinical practice. II. Problems for managers, clinicians and patients. Med Care Rev. 1981;38:195–216.

    Article  PubMed  CAS  Google Scholar 

  12. McPhee S, Richard R, Solkowitz S. Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society Guidelines. J Gen Intern Med. 1986;1:275–81.

    Article  PubMed  CAS  Google Scholar 

  13. 1989 survey of physicians’ attitudes and practices in early cancer detection. CA Cancer J Clin. 1990;40:77–101.

  14. McDowell I, Newell C, Rosser N. Computerized reminders to encourage cervical screening in family practice. J Fam Pract. 1989;28:420–4.

    PubMed  CAS  Google Scholar 

  15. Pierce M, Lundy S, Palanisamy A, Winning S, King J. Prospective randomised controlled trial of methods of call and recall for cervical cytology screening. BMJ. 1989;299:160–2.

    Article  PubMed  CAS  Google Scholar 

  16. Turner B, Day S, Borenstein B. A controlled trial to improve delivery of preventive care: physician or patient reminders? J Gen Intern Med. 1989;4:403–9.

    Article  PubMed  CAS  Google Scholar 

  17. Wolosin R. Effect of appointment scheduling and reminder postcards on adherence to mammography recommendations. J Fam Pract. 1990;30:542–7.

    PubMed  CAS  Google Scholar 

  18. Petravage J, Swedberg J. Patient response to sigmoidoscopy recommendations via mailed reminders. J Fam Pract. 1988;27:387–9.

    PubMed  CAS  Google Scholar 

  19. Walsh J, Kaplan C, Nguyen B, Gildengorin G, McPhee S, Perez-Stable E. Barriers to Colorectal Cancer Screening in Latino and Vietnamese Americans. J Gen Intern Med. 2004;19:156–66.

    Article  PubMed  Google Scholar 

  20. Walsh J, McPhee S. A systems model of clinical preventive care: an analysis of factors influencing patient and physician. Health Educ Quarterly. 1992b;19:157–75.

    CAS  Google Scholar 

  21. Soumerai SB, Avorn J. Principles of educational outreach (“academic detailing”) to improve clinical decision making. JAMA. 1990;263:549–56.

    Article  PubMed  CAS  Google Scholar 

  22. Imperiale T, Wagner D, Lin C, Larkin G, Rogge J, Ransohoff D. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–74.

    Article  PubMed  CAS  Google Scholar 

  23. Lieberman D, Weiss D, Bond J, Ahnen D, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.

    Article  PubMed  CAS  Google Scholar 

  24. SAS Institute. SAS Online Doc®. Version 8. Cary, NC: SAS Institute, Inc.; 1999.

    Google Scholar 

  25. American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin. 2001;51:87–8.

    Google Scholar 

  26. Cram P, Fendrick A, Inadomi J, Cowen M, Carpenter D, Vijan S. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med. 2003;163:1601–4.

    Article  PubMed  Google Scholar 

  27. Podolsky D. Going the distance—the case for true colorectal-cancer screening. N Engl J Med. 2000;343:207–8.

    Article  PubMed  CAS  Google Scholar 

  28. DeLaet D, Shea S, Carrasquillo O. Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans. J Gen Intern Med. 2002;17:451–7.

    Article  PubMed  Google Scholar 

  29. Rizzo J. Are HMOs bad for health maintenance? Health Econ. 2005; in Press.

  30. Greene J, Blustein J, Laflamme K. Use of preventive care services, beneficiary characteristics, and medicare HMO performance. Health Care Financing Rev. 2001;22:141–53.

    CAS  Google Scholar 

  31. Buchner D, Larson E, White R. Influenza vaccination in community elderly. A controlled trial of postcard reminders. J Am Geriatr Soc. 1987;35:755–60.

    PubMed  CAS  Google Scholar 

  32. Zubarik R, Eisen G, Zubarik J, et al. Education improves colorectal cancer screening by flexible sigmoidoscopy in an inner city population. Am J Gastroenterol. 2000;95:509–12.

    Article  PubMed  CAS  Google Scholar 

  33. Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133:761–9.

    PubMed  CAS  Google Scholar 

  34. Tilley B, Vernon S, Myers R, et al. The Next Step Trial: impact of a worksite colorectal cancer screening promotion program. Prev Med. 1999;28:276–83.

    Article  PubMed  CAS  Google Scholar 

  35. Friedman L, Everett T, Peterson L, Ogbonnaya K, Mendizabal V. Compliance with fecal occult blood test screening among low-income medical outpatients: a randomized controlled trial using a videotaped intervention. J Cancer Educ. 2001;16:85–8.

    PubMed  CAS  Google Scholar 

  36. Dolan J, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22:125–39.

    Article  PubMed  Google Scholar 

  37. Wardle J, Williamson S, McCaffery K, et al. Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults. Health Psychol. 2003;22:99–105.

    Article  PubMed  Google Scholar 

  38. Powe B. Promoting fecal occult blood testing in rural African American women. Cancer Pract. 2002;10:139–46.

    Article  PubMed  Google Scholar 

  39. Zapka J, Lemon S, 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;141:683–92.

    PubMed  Google Scholar 

  40. Snell J, Buck E. Increasing cancer screening: a meta-analysis. Prev Med. 1996;25:702–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, Calif, USA

    Judith M. E. Walsh MD, MPH, René Salazar MD, Ginny Gildengorin & Eliseo J. Pérez-Stable MD

  2. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, Calif, USA

    Jonathan P. Terdiman MD

Authors
  1. Judith M. E. Walsh MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. René Salazar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan P. Terdiman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ginny Gildengorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eliseo J. Pérez-Stable MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Judith M. E. Walsh MD, MPH.

Additional information

The authors have no conflicts of interest to report.

Grant support: Dr Walsh was funded by an American Cancer Society Cancer Control Career Development Award, and also received funding from the UCSF Comprehensive Cancer Center. Drs. Gildengorin, Salazar, and Pérez-Stable were supported by a grant from the UCSF Center for Aging in Diverse Communities.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Walsh, J.M.E., Salazar, R., Terdiman, J.P. et al. Promoting use of colorectal cancer screening tests. J GEN INTERN MED 20, 1097–1101 (2005). https://doi.org/10.1111/j.1525-1497.2005.0245.x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0245.x

Key Words

Search

Navigation