Results Summary

What was the research about?

Colorectal cancer is the second leading cause of cancer deaths among US patients who are Hispanic. Screening can help find this cancer early, when it is easier to treat. Doctors mainly use two screening tests:

  • A stool blood test kit. People who use this test collect samples of their stool at home and mail them to a lab. The lab tests for blood in the stool, which can be an early sign of colorectal cancer.
  • A colonoscopy. In this test, doctors insert a long, flexible tube into the rectum and large intestine, or colon. A camera at the end of the tube lets doctors see changes in the colon that may indicate cancer.

In this study, the research team compared two ways to encourage Hispanic patients to get a screening test. In one way, the team mailed patients a stool blood test kit and information about how to schedule a colonoscopy. In the other way, patients got the same mailing plus a phone call to help patients decide which screening test was better for them and help them get their preferred test.

What were the results?

Compared with patients who received only the mailing, patients who also received a phone call were more likely to get a screening test for colorectal cancer in the next year.

Patients who received the phone call did not know more about colorectal cancer and screening than those who received only the mailing.

Who was in the study?

The study included 400 Hispanic patients ages 50–75 who were overdue for colorectal cancer screening. Of these, 59 percent were women, and 69 percent were ages 50–59. In addition, 83 percent spoke Spanish at home. All patients went to one of five doctors’ offices in southeast Pennsylvania.

What did the research team do?

The research team assigned patients by chance to one of two groups. In the first group, patients got a mailing that included a letter from patients’ doctors encouraging patients to get a screening, a brochure about colorectal cancer screening tests, a stool blood test kit, and instructions for scheduling a colonoscopy. The materials were in English and Spanish. The team mailed a reminder after 45 days if patients hadn’t done either screening test.

In the second group, patients received the same mailing and follow-up. In addition, a staff member called them a week after the mailing. During the call, the staff member

  • Reviewed the mailed materials
  • Used an online guide to help patients figure out what was keeping them from having a screening test
  • Created a screening plan and sent it to the patients and their doctors
  • Reviewed instructions with patients who wanted to do a stool blood test
  • Scheduled a prescreening clinic visit if patients wanted a colonoscopy

After one year, the research team looked at health records to see if patients had done either test. The team also surveyed patients by phone six months after the study started. The survey asked patients what they knew about colorectal cancer and screening.

A group of patients, Hispanic community leaders, and doctors reviewed the study plan and gave feedback to the research team.

What were the limits of the study?

The study included Hispanic patients from five doctors’ offices in one healthcare system in one state. The results may be different for Hispanic patients in other healthcare settings or in different parts of the country. Future research could look at phone support for getting a screening test with people from other places or backgrounds.

How can people use the results?

Health systems could use phone support to help Hispanic patients get screening tests for colorectal cancer.

Final Research Report

View this project's final research report.

More to Explore...

Blogs

Encouraging Colorectal Cancer Screening among Hispanics
One of the more than 100 PCORI-funded studies that are addressing disparities in health and healthcare takes on colorectal cancer, for which early detection save lives: 90 percent of people whose colorectal cancer is early stage at diagnosis live for at least five years, but only 14 percent of people whose cancer has spread to other parts of the body survive that long. Screening rates differ between groups of people, with Hispanics/Latinos falling behind whites. In this blog post, two members of a research team share insights and results from tests of a method to increase screening among Hispanics.

Videos

Increasing Colon Cancer Screening Rates in the Hispanic Population (right)
Hear more about how this study compared the effectiveness of two communication approaches by the Lehigh Valley Health Network in Pennsylvania to increase the colon cancer screening rate among Hispanics.

Decision Support and Navigation
Study principal investigator Ronald E. Myers, PhD says that decision support and navigation—an approach studied through his study—has potential to change practice if a centralized process is adopted and implemented by health systems.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers expressed concern about the substantial number of patients in the study source population who did not participate in the research and therefore, whether the patients who agreed to participate were truly representative of the source population. The researchers explained in the report that they compared characteristics of patients included in the study to those of the source population. The comparisons indicated that patients included in the study were more likely to be under 60 years old and to come from certain primary care practices than those in the source population.
  • Reviewers noted that the report did not sufficiently discuss the low rates of stool blood test rescreening, despite a much higher rate of initial screenings in the navigator intervention group compared to the standard practice group. The researchers hypothesized in the report’s discussion that the low rate of rescreening in the intervention group was due to the lack of additional intervention contacts, which reduced motivation in this group. The investigators hypothesized further that comparison patients, however, had to be more self-motivated from the beginning to complete the stool blood test initially and therefore, probably had a higher rate of motivation to follow the guidelines for annual screening.

Conflict of Interest Disclosures

Project Information

Ronald E. Myers, PhD
Thomas Jefferson University
$1,833,727
10.25302/8.2019.AD.130601882
Increasing CRC Screening Among Hispanic Primary Care Patients

Key Dates

December 2013
October 2018
2013
2018

Study Registration Information

Tags

Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Funding Opportunity Type
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
Research Priority Area
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 20, 2023