Quality Improvement of Patient-Provider Communication For Colorectal Cancer Screening

Not Applicable

Completed

Brief Summary: The immediate objective of this proposal is to assess the effectiveness of a multi-faceted intervention to improve patient-provider communication about colorectal cancer screening in improving patient adherence with colorectal cancer screening recommendations. This intervention consists of: (1) guiding the communication process through patient activation to initiate a colorectal cancer screening discussion; (2) optimizing communication content through the use of a prompt sheet; and (3) cueing the provider to assess patient perception of the communication. The long-term objective of our research program is to maximize colorectal cancer screening rates throughout the VA through widespread adoption of clinically feasible approaches to enhance patient-provider communication.

Detailed Description: In the United States, colorectal cancer is the third most common cancer and the second leading cause of cancer mortality with over 56,000 deaths in 2004). Early detection through screening decreases the mortality associated with the disease. However, adherence with current screening recommendations is low. A survey of the general population indicates that only 53.1% of Americans, age 50 years and older for whom colorectal cancer screening is recommended, are up-to-date with this preventive service. While colorectal cancer screening rates with the VA Healthcare System (VHA) are better than in the general population (75% in Fiscal Year (FY) 2005), they are lower than performance rates for other types of cancer screening (e.g., mammography) in VHA. Further, numerous VA medical centers report colorectal cancer screening rates below the level considered satisfactory.

Recruitment & Eligibility

Inclusion Criteria

Provider Eligibility:

Primary care providers (MD, Certified Registered Nurse Practitioner (CRNP), or PA) at the study sites who see patients in the primary care setting at least 1 day per week and had no involvement in the design of the study are eligible for enrollment in the study.

Patient Eligibility:

Primary care patients who are not "up-to-date" with colorectal cancer screening are the targeted population for study enrollment.
Up-to-date with colorectal cancer screening is defined as having completed one of the following:
- fecal occult blood testing within the past year
- sigmoidoscopy within the past 5 years
- colonoscopy within the past 10 years
- barium enema within the past 5 years.
Other patient eligibility criteria are:
- Primary Care Provider (PCP) enrolled in the study
- clinic visit scheduled with the enrolled PCP during the recruitment period
- English speaking
- no prior history of colorectal cancer or adenomatous polyps
- no prior history of inflammatory bowel disease

Exclusion Criteria

Patients who are deemed clinically not appropriate for colorectal cancer screening due to severe comorbidity and/or limited life expectancy as determined by the patient's primary care provider will be excluded from the study.

Arm && Interventions

Group	Intervention	Description
Intervention	Communication	Communication sheet
Control	Standard of care	Standard of care brochures

Primary Outcome Measures

Name	Time	Method
Completion of Colorectal Cancer Screening Tests	6-12 months	A survey collected data on patient demographic characteristics, family history of colorectal cancer or polyp, and provider recommendation for colorectal cancer screening, if any. In addition, we asked patients whether colorectal cancer screening was discussed at the visit. If the response was yes, we then asked patients how satisfied they were with the PCP communication during the visit in general using a 5-point Likert scale to a number of items describing the communication. A medical record review was conducted to collect data on provider ordering and patient completion of the following colorectal cancer screening tests during the study period (i.e., 6 months from the time of the clinical encounter): fecal occult blood testing, sigmoidoscopy, or colonoscopy.
Communication Content	immediately after the patient visit	PCP Explains CRC screening to my satisfaction
Quality of Communication	immediate after the patient visit	Patient satisfaction with the discussion of Colorectal Cancer (CRC) screening with the primary care provider (PCP).

Secondary Outcome Measures

Name	Time	Method

Locations (3): Jesse Brown VA Medical Center, Chicago, IL
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Chicago, Illinois, United States
Michael E. DeBakey VA Medical Center, Houston, TX
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Houston, Texas, United States
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
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Pittsburgh, Pennsylvania, United States