Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the U.S. and CRC risk increases with age. Most organizations suggest that, for those at average risk screening should be initiated at age 50. Colorectal cancer screening (CRCS) is cost-effective and offers the possibility of early detection as well as prevention. However, the use of every CRCS test is low and has not increased substantially in recent years. Clearly, interventions to increase screening are needed. The primary goal of this 5-year research project is to conduct a prospective randomized trial of a tailored interactive computer-based intervention to increase patient completion of CRCS among patients aged 50-64 years in a multi-specialty primary care practice in Houston, TX. A stratified random sample based on sex and prior screening history will be recruited. The primary outcome will be completion of any CRCS test (following ACS guidelines) within 6 months of the intervention. Secondary goals are to increase understanding of factors that predict completion of CRCS and to assess the cost-effectiveness of the intervention. The transtheoretical (stages of change) model will be used to guide intervention development. To implement our specific aims we will use Intervention Mapping, a framework for systematic health promotion program planning that incorporates theory and empiric evidence to identify determinants of a behavior, develop intervention objectives, and select methods and strategies for an intervention. The intervention will be delivered immediately prior to a patient's clinic visit via a personal computer installed in the clinic's Patient Education Center. It will be an interactive audiovisual program tailored to a participant's status on a series of variables including readiness to engage in CRCS. The interactive program will generate a checklist of questions and concerns identified by the patient that can be used to initiate a discussion about CRCS with the physician. Two comparison groups will be included: a no-contact control group and a control group who receive generic printed CRCS educational materials immediately prior to their clinic visit. All three groups will involve the provision of a physician reminder placed in the medical chart prior to the clinic visit. Telephone follow-up and medical record review will be conducted 6 months after delivery of the intervention to ascertain completion of CRCS.
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