Adenocarcinoma of the colon and rectum is a major cause of death from cancer in the United States and most authorities now recommend that persons over age 50 be offered screening for colorectal cancer (CRC) because of recent evidence that screening is effective in reducing CRC mortality. However, rates of patient adherence with screening sigmoidoscopy recommendations are low and little research has been done to explain this limited compliance or to identify methods for increasing patient participation. We propose a randomized trial to measure the efficacy of an educational video in increasing compliance with flexible sigmoidoscopy screening (primary trial outcome). Subjects are established primary care patients who have a scheduled non-urgent appointment with their primary care physician. A stratified sample (gender/age) of 600 people will be randomized to the intervention or comparison condition. Intervention subjects will be mailed a video cassette with accompanying written brochure prior to their appointment. It will emphasize patient-centered education and will utilize role models to discuss barriers and enhance motivation. During their visit, patients in both study conditions will receive a standardized recommendation on CRC and printed material from the physician. The primary trial outcome is completion of the recommended sigmoidoscopy. Secondary outcomes include initial acceptance of the recommendation, and selected knowledge, attitude and belief measures which are hypothesized to be influenced by the video. Telephone interviews will be conducted at baseline (To), directly after the appointment (T1), and within four months after the primary care visit during which period a sigmoidoscopy could have been completed (T2). The content and format of the video will be informed by focus groups and a random digit dial survey of a representative sample of Massachusetts residents over age 50. The survey will identify knowledge levels, beliefs, and attitudes about CRC and sigmoidoscopy; document rates of CRC screening; and identify factors independently related to sigmoidoscopy screening intention and behavior, including personal predisposing factors and enabling and reinforcing health system factors and other potential mediating factors.
