Colorectal cancer (CRC) is the second leading cause of cancer related death in the U.S. Unfortunately, past and current efforts have failed to increase CRC screening to the NCI 2000 goal of 50% of people aged 50-70. Typical interventions to promote CRC screening in primary care are sporadic and lack a mechanism to achieve the combined involvement of the physician, patient, and practice. While tracking systems are useful for ensuring patient compliance with other types of cancer screening (e.g. Paps), they are rarely used for CRC screening. This randomized controlled trial will evaluate a multi-level intervention designed to (1) activate the decision-making process between the provider, patient, and practice, and (2) ensure follow through with screening decision. 300 patients between the age of 50-70 who schedule a health maintenance visit in one of l0 practices in the Colorado Research Network will be eligible. Just before their visit, intervention patients will view an interactive educational module on a handheld computer. The module will address the known issues that patients consider when making a decision about CRC screening, such as prevalence of and vulnerability to CRC and the cost and pain associated with screening. After viewing the program, patients will take the computer to their clinician, where she/he will enter the patient's screening decision into a tracking program. Reminder letters sent by the practice will help patients remember to follow through with their decision. Both the intervention group and a comparison group will receive a mailed educational brochure, but the comparison group will receive no further intervention. Our primary aim is to test the effectiveness of a multi-level intervention to improve 12 month rates of (number of people who receive) CRC screening. Secondarily, we will use mixed methods to describe those practice, provider, and patient factors that influence whether and how the intervention components are implemented in primary care. This study will demonstrate that a primary care practice-based research network can gather and systematically assess data on CRC screening delivery, utilization, and short-term outcomes. The results will indicate the feasibility and utility of the intervention and will also shed light on the factors that influence patient decisions to comply with primary care providers' recommendations regarding CRC screening. Furthermore, this method of education and tracking is not specific to CRC and could provide opportunities for increasing screening rates for other types of cancer. ? ? ?
