Application) With continuing high mortality rates associated with colorectal cancer and with rising incidence rates in some minority populations, improving screening rates for this cancer becomes increasingly important. We propose a study that will test the effect of a physician- or staff-initiated discussion of personalized patient risk information for cancer on patient compliance for FOBT and sigmoidoscopy (or colonoscopy if indicated) within three months of intervention. This study will be implemented in Arizona?s most populous county, Maricopa, within the indigent health care system reaching a high proportion of underserved, often minority patients. Patients will be randomized by clinic to three arms of study: (a) Risk discussion presented by physician/clinician, (b) Risk discussion presented by staff such as nurse or educator in clinic, (c) no risk discussion (control). Over a year?s time, fifteen clinics will refer 150-200 patients each for screening. In clinics randomized to the physician- or staff-initiated risk discussion treatment, the Harvard Cancer Risk Index (to be translated to local Spanish) will be completed by patients while waiting for a visit to their doctor. Results of their scores will be discussed by the doctor or a professional staff member, such as a nurse or educator with emphasis on need for colorectal cancer prevention and screening. In all groups, including control, physicians and staff will receive academic detailing concerning the importance of colorectal cancer screening, and will be given a systematic reminder to refer eligible patients. Hypothesis 1: Conducting personalized cancer risk discussions with patients will improve the rates of patient compliance with the referrals to be screened for colorectal cancer by 10% over the rates of those patients receiving no risk discussion. Research Question 1: Which source of cancer risk discussions will improve the rates of patient compliance with the recommended colorectal early detection tests more, physician or staff initiated?
