The cancer control services provided to primary care patients often falls short of the ideal. Though methods to improve physician cancer control performance are known, they have not been widely disseminated. This proposal describes a phase IV Project to test the impact of Intensive and Minimal Strategies to disseminate NCI Working Guidelines for Early Cancer Detection and an Office Cancer Control System that previously has been shown to improve the cancer control performance of volunteer NH and VT physicians in the Cancer Prevention in Community Practice (CPCP) Project. The System is based on a preventive flow sheet in patients' charts and shared cancer control responsibilities among an office's physician(s) and staff. The dissemination strategies to be tested include physician education about cancer control Guidelines and the System plus external implementation support (the Intensive strategy) and the same education without implementation support (the Minimal strategy). Both strategies will be provided through intermediary organizations, the Vermont and New Hampshire state divisions of the American Cancer Society, working with the defined population of remaining NH and VT family physicians and general internists who didn't participate in CPCP. All of the primary physicians in each of the two states will receive education through mailed written materials and at least three opportunities to attend a Cancer Control Education Conference offered as part of the well-established and well-attended continuing medical education programs of specialty groups, state medical societies and hospital grand rounds. An estimated 50-70% of target physicians will attend. After attending, physicians who agree to cooperate with evaluation will be randomly assigned to receive implementation support (the Intensive strategy) or not (the Minimal strategy) and then followed for twelve months. We estimate that there will be at least 100 practices represented in each study group. Evaluation subpopulations will include physicians who attend the Conference and those who do not attend. Both how physicians change their office cancer control procedures in response to dissemination efforts and what cancer control services the physicians actually provide to their patients as a result will be addressed. Evaluation will include 3500 Record Reviews for two time periods, 3500 Patient Exit Questionnaires at two intervals, Physician and Office Staff Questionnaires, and Physician and Office Staff Interviews. This project is a predecessor to phase V dissemination efforts and will develop relevant research instruments and methodologies; identify barriers to dissemination; provide insights about the role of intermediary organizations in such programs; and test the impact of these strategies.
| Dietrich, A J; Sox, C H; Tosteson, T D et al. (1994) Durability of improved physician early detection of cancer after conclusion of intervention support. Cancer Epidemiol Biomarkers Prev 3:335-40 |
| Dietrich, A J; Woodruff, C B; Carney, P A (1994) Changing office routines to enhance preventive care. The preventive GAPS approach. Arch Fam Med 3:176-83 |
