This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.
What is the research about?
Colorectal cancer, or CRC, is cancer of the colon, or large intestine. Regular screening can often prevent CRC. One way to screen for CRC is with a colonoscopy. With this test, a doctor inserts a long, flexible tube into the rectum and colon. A camera at the end of the tube lets the doctor see changes in the colon that may mean cancer is present. Another way to screen for CRC is with a stool test, also known as a fecal immunochemical test, or FIT. FIT checks the stool for blood, which may be a sign of CRC. Both ways of screening are effective for adults at average risk for CRC. For most people, screening should start at age 50 and continue to age 75. Recent changes in screening guidelines show that African Americans should start screening at age 45.
Many people don’t get screened regularly. Some patients referred for a colonoscopy find the bowel preparation difficult. Other patients avoid colonoscopy because of cost, fear, or lack of transportation. Some patients don’t understand the point of having a colonoscopy when they don’t have any problems. If doctors only offer colonoscopy and don’t discuss FIT as a screening option, some patients may decide not to be screened at all.
Programs that increase patients’ knowledge about CRC and CRC screening, while also addressing patients’ concerns, may improve screening rates. In this study, the research team is comparing ways to motivate and prepare patients to get screened.
Who can this research help?
Healthcare systems can use the results from this study when considering how to help patients make informed decisions about CRC screening.
What is the research team doing?
The research team is enrolling 384 adults who were scheduled for a colonoscopy but canceled or didn’t go to their appointment. The team is assigning participants by chance to one of three groups.
In the first group, each patient receives a mailed DVD about CRC screening at the patient’s health system. The DVD has information about CRC screening tests and about concerns the patient may have in getting CRC screening. The 20-minute DVD shows how cancer develops, the benefits of screening, how doctors perform colonoscopy, and how to do a FIT at home. Patients can choose to see information about either or both tests on the DVD.
The second group receives the mailed DVD plus telephone calls from a nurse who answers patients’ questions, counsels them on the benefits of screening, addresses issues like cost or transportation, and helps patients access screening.
The third group receives the usual care provided to all patients scheduled for colonoscopy in the healthcare system. Usual care includes a phone call to remind patients of their appointment and answer questions about how to prepare for the colonoscopy.
The research team is looking at patients’ medical records 6, 9, and 12 months after they start the study to see if they got screened with either colonoscopy or FIT. For patients who got a colonoscopy, the team is also looking at how well the patients followed instructions to prepare their bowel for the test.
In addition, the research team is interviewing patients by phone at the start of the study, two weeks after mailing the DVD, and after 6 and 9 months. The team is comparing the groups on
- What patients know about CRC and screening
- If patients think it’s likely that they will get CRC
- What benefits patients see to CRC screening
- What concerns patients have about CRC screening
- How confident patients are in their ability to get screened
- How much anxiety patients have about colonoscopy
- Patients’ satisfaction with the tailored DVD and patient navigation
A community advisory board made up of patients like those in the study is helping plan and conduct the study.
Research methods at a glance
Training and Education Interventions
- Sandra Bailey
- Beatrice Cork
- Thomas Griffin
- Juan Lagunes
- Ruth Lambert
- Sylvia Strom
Other Stakeholder Partners
- Hala Fatima, MBBS, Eskenazi Health
- Kimberly Mitchell, RN, Eskenazi Health