The lifetime risk of colorectal cancer is over 5% in the United States where, despite recent declines in incidence and mortality, colorectal cancer remains the second highest cause of cancer death. Better treatments have improved survival rates, but morbidity and mortality could be more rapidly and cost-effectively reduced by achieving higher uptake and long-term adherence to colorectal cancer screening. The Systems of Support to Decrease Colorectal Cancer (SOS) study successfully advanced colorectal screening. SOS was a 4-arm randomized controlled trial that leveraged electronic health record data and automated systems to implement stepwise increases in screening support. Patients due for screening (n=4675) were randomized to (1) Usual Care, (2) Automated care (automated mailings and fecal occult blood tests), (3) automated plus assisted care from medical assistants (phone reminders and sending orders to physicians to sign), or (4) automated + assisted + navigated care from registered nurses (follow-up until test completion). Interventions were repeated in year 2. Compared to usual care, intervention patients were more likely to be current for colorectal cancer screening in both study years, with increases by intervention intensity: Usual Care 26.5%, Automated 50.7%, Assisted 57.7%, and Navigated 64.4% (P<.001). We propose to improve and continue SOS interventions up to 10 years and measure their effects on long-term adherence and outcomes. We will: 1. Identify factors related to low or non-adherence to screening despite receiving continued interventions and apply these findings to a stepped intervention to increase uptake and long-term adherence of screening. 2. Assess the effectiveness of the SOS interventions on long-term screening adherence up to 10 years. 3. Describe the impact of SOS interventions on colorectal cancer-related costs and clinical outcomes.

Public Health Relevance

Colorectal cancer is the second leading cause of cancer death in the United States. Screening decreases colorectal cancer deaths. Our SOS program used electronic health records and mailed and telephone support to increase rates of colorectal cancer screening. In this project, we improve the SOS program and continue it for 10 years to find out how to promote long-term, consistent screening that decreases cancer deaths.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Klabunde, Carrie N
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Group Health Cooperative
United States
Zip Code
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; Fuller, Sharon; Anderson, Melissa L et al. (2017) A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team. J Fam Med 4:
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
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
Green, Beverly B; Coronado, Gloria D (2014) ""BeneFITs"" to increase colorectal cancer screening in priority populations. JAMA Intern Med 174:1242-3
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
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

Showing the most recent 10 out of 17 publications