Colorectal cancer is the second most common cause of cancer death in the United States. Early detection and intervention can significantly reduce morbidity and mortality from colorectal cancer (CRC), and current guidelines recommend that asymptomatic adults overage 50 periodically obtain screening by one of several modalities (FOBT, sigmoidoscopy,colonoscopy,or double contrast barium enema). However, CRC screening remains substantially underutilized in the U.S., and more than half of all adults do not adhere to these recommendations. Because key predictors of CRC screening utilization include a physician recommendation and having health insurance, and given the availability of evidence-based strategies for increasing screening uptake, it is important to conduct effectiveness studies in health plan member populations. Our research team proposes to conduct participatory research with a major health insurer, in order to test the transferability of community based behavioral interventions that can increase provision of colorectal cancer screening. We will conduct a cluster-randomized trial in health practices in Georgia and North Carolina, to test the effectiveness of a videotape-based decision aid and academic detailing for increasing adherence to CRC screening guidelines. 30 large group practices will be recruited and randomized to receive usual care (routine reminders) or a combined videotape decision aid and academic detailing intervention. In each practice, 30 patients between the ages of 52 and 75, without current CRC screening history, will be enrolled into the study. The intervention will continue for up to 2 years for still-unscreened participants. The main outcome will be provision (or receipt) of an evidence-based modality of CRC screening according to the US Preventive Services Task Force Guidelines (FOBT, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema). The research team has already begun a participatory research process with key leaders in Quality Improvement and the Medical Economics Units at Aetna, one of the nation's largest health insurers. Unique features of the proposed study include its potential to establish systems to increase screening uptake that will help fulfill HEDIS requirements; improving our understanding of how screening promotion interventions work in both White and Black populations; and forging collaborative relationships between public health and health care researchers, and the affected communities of health plans and health care providers.

National Institute of Health (NIH)
Public Health Practice Program Office (PHPPO)
Research Project (R01)
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Special Emphasis Panel (ZPH1-EWS (PH))
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Emory University
Schools of Public Health
United States
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Pignone, Michael; Winquist, Andrea; Schild, Laura A et al. (2011) Effectiveness of a patient and practice-level colorectal cancer screening intervention in health plan members: the CHOICE trial. Cancer 117:3352-62
Pignone, Michael; Scott, Tracy L; Schild, Laura A et al. (2009) Yield of claims data and surveys for determining colon cancer screening among health plan members. Cancer Epidemiol Biomarkers Prev 18:726-31