Colorectal cancer (CRC) is the third leading type of cancer and the third leading cause of cancer death in the United States. Ohio has higher than average rates of CRC mortality. Our study population will also include minority and older individuals as these groups have higher CRC incidence and mortality rates. The goal of this study is to test a program to improve CRC screening among male and female patients over the age of 50 in 12 primary care clinics of The Ohio State University Primary Care Network. This study will use physician surveys, focus groups and a community advisory board to finalize the content of the interventions. Five theoretical models form the theoretical framework of the study - the health belief model, social networking, minority health and communications model, Pen III, and the Transtheoretical model. The intervention program will be directed at the clinic and patient levels, and will be tested in a group randomized design. Six clinics will receive the intervention program consisting of clinic and patient-directed interventions and 6 clinics will be randomized to usual care. The clinic intervention component consists of provider, system, and waiting room activities. The individual-directed intervention component begins 12 months after the clinic-directed component will include three stepped stages for patients who have not yet been screened: (1) a tailored physician letter, easy-to-read educational materials about CRC and an FOBT information sheet and card;(2) follow-up telephone barriers counseling for patients who do not complete CRC screening within 3 months after receiving the letter;and(3) in-person home visits by Lay Health Advisors (LH/l) for those who do not complete CRC screening within 3 months after receiving the first two interventions. We will conduct a process evaluation of the interventions to identify problems in implementing them and determine the extent to which each component is successfully carried out. The overall evaluation of the program will determine the effectiveness of the program in increasing CRC screening of men and women over the age of 50 through analyses of two independent cross sectional analyses of medical records in our 12 clinics, and pre and post test interviews among a randomly- selected cohort of 1128 patients. We will also examine how components of the intervention relate to the theoretical frameworks used to motivate CRC screening completion. If successful, this program can easily be adapted for use by primary care practices and clinics to improve CRC screening.
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