Social learning theory postulates that future behavior is the result of cognition, previous behavior, and environment. Using a 2x2 factorial design, this project will test the impact of 2 interventions rooted in social learning theory on physician cancer prevention/control behaviors. One intervention will alter the practice environment through a new office system that will provide systematic support for a physician's cancer control behaviors. The other will provide physicians training to improve their preventive knowledge, attitudes, and skills. Both will attempt to improve physicians' ability to assess a patient's preventive needs, initiate appropriate action, and monitor compliance. Target preventive areas addressed include smoking, nutrition, and early detection of breast, cervical, and colon cancer. Eighty practices drawn from the Dartmouth Cooperation Information Project and the Vermont and New Hampshire Chapters of the American Academy of Family Practice will provide the sample. The individual and combined impact of interventions will be compared to controls. The outcome variable will be the Physician Preventive index, the proportion of physicians' cancer prevention/control services actually provided to patients compared to services recommended by experts. The study will have a power of 0.82 to detect an absolute improvement of 0.20 on the index (range 0.0 - 1.0). The index will be based on Record Review and Patient Report done at baseline and during 2 follow-up periods. These quantitative measures will be supplemented by a simulated patient method that will evaluate the quality of selected preventive behaviors. This project will test the hypothesis that changing physicians' office environment and preventive attitudes, knowledge and skills improve physician preventive behavior.
