Colorectal cancer screening (CRCS) decreases colorectal cancer mortality and incidence however, 40-60% of eligible adults are not screened at recommended intervals, and many have never had any type of CRCS. Screening failures occur from both lack of screening and breakdowns in follow-up of positive tests. Strategies for improving the uptake of CRCS typically focus on either patients or health care providers, without describing the infrastructure changes, or systems of support (SOS), that are required to implement and sustain these changes. We propose a two-part study using the Chronic Care Model to organize SOS. We will identify a cohort of Group Health patients aged 50 -75 years whose CRCS is not current according to national guidelines. In Part A: Subjects will be randomized to receive one of four interventions of stepwise increasing intensity of support: 1.Usual care (UC). 2.Automated support (UC+ mailed information, fecal occult cards (FOBT) and reminders, and access to a cancer screening hotline to discuss other screening options). S.Assisted support (UC+ automated + a medical assistant to record choice and assists patients in completing the choice via the resources already supplied or sending requests to the patient's physician). 4.Nurse care management support (UC + automated + assisted + a cancer screening nurse who manages patient care by clarifying patient CRCS intent, assessing procedural risk, ordering tests, and assists with completion of the action plan). In Part B: Patients with a positive FOBT or flexible sigmoidoscopy (colonoscopy needed) will be randomized to one of two follow-up intervention arms. A.UC (which at Group Health includes a registry and physician alerts) or B.Nurse care management (UC + cancer screening nurse who manages care after a positive test. Our study hypotheses are that: 1. increasing levels of SOS wil result in increasing CRCS rates and 2. care management by cancer screening nurses will increase follow-up rates after a positive test. The primary specific aims are: 1. To compare the effectiveness of each intervention condition on increasing CRCS rates 2. To compare the effectiveness of each intervention condition on follow-up after a positive screening test The secondary aims are: 3. To assess the effects of each intervention condition on participants'cognitive, affective, and social factors related to CRCS adherence and satisfaction with medical services 4. To compare utilization, costs, and incremental cost-effectiveness of each intervention condition

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
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Klabunde, Carrie N
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Group Health Cooperative
United States
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Green, Beverly B; Anderson, Melissa L; Cook, Andrea J et al. (2017) A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial. Cancer 123:4472-4480
Green, Beverly B; BlueSpruce, June; Tuzzio, Leah et al. (2017) Reasons for never and intermittent completion of colorectal cancer screening after receiving multiple rounds of mailed fecal tests. BMC Public Health 17:531
Green, Beverly B; Anderson, Melissa L; Chubak, Jessica et al. (2016) Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH). J Am Board Fam Med 29:191-200
Green, Beverly B; Anderson, Melissa L; Chubak, Jessica et al. (2016) Impact of continued mailed fecal tests in the patient-centered medical home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up randomized trial. Cancer 122:312-21
Meenan, Richard T; Anderson, Melissa L; Chubak, Jessica et al. (2015) An economic evaluation of colorectal cancer screening in primary care practice. Am J Prev Med 48:714-21
Laing, Sharon S; Bogart, Andy; Chubak, Jessica et al. (2014) Psychological distress after a positive fecal occult blood test result among members of an integrated healthcare delivery system. Cancer Epidemiol Biomarkers Prev 23:154-9
Green, Beverly B; Coronado, Gloria D (2014) ""BeneFITs"" to increase colorectal cancer screening in priority populations. JAMA Intern Med 174:1242-3
Green, Beverly B; Anderson, Melissa L; Wang, Ching-Yun et al. (2014) Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial. J Am Board Fam Med 27:789-95
Wang, Ching-Yun; de Dieu Tapsoba, Jean; Anderson, Melissa L et al. (2014) Time to screening in the systems of support to increase colorectal cancer screening trial. Cancer Epidemiol Biomarkers Prev 23:1683-8
Murphy, Caitlin C; Vernon, Sally W; Haddock, Nicole M et al. (2014) Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial. Prev Med 66:123-30

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