Low-Literacy Physician-Patient Intervention Promoting Colorectal Cancer Screening

This study will test the separate and combined effect of two of these interventions: 1) a
provider communication skills training using a continuous quality improvement (CQI)
framework, and 2) a brief, multimedia Patient Education Program (PEP) that incorporates
plain language, graphic design, and audio voice-over to overcome literacy limitations. Our
provider intervention has demonstrated efficacy to significantly improve CRC screening
recommendation rates. Our multimedia program has also been field tested among patients with
limited literacy and was able to improve patient knowledge and intention to receive
screening.

We will implement both provider-only and combined provider-patient strategies within a
federally qualified health center network to determine the most effective and efficient
approach to promote CRC screening in these settings. Results from the study, supplemented by
cost analyses and the process evaluation will directly inform translational strategies for
cancer prevention within difficult community-based healthcare settings.

Inclusion Criteria:

- Patients aged 50-75 years of age (in month 1 of the study)

- Patients have had two or more visits to the clinic during the past two years (April
1, 2008 and March 31, 2010)

- ACCESS Community Health Network Patients

- Patients ages 50 - 75 as of the start of the intervention study (as of 03/31/2010)

- English or Spanish-Speaking

Exclusion Criteria:

- Patients <50 or > 75 years of age as of 03/31/2010

- Patients who have had fewer than two or more visits to the clinic during the past two
years (April 1, 2008 and March 31, 2010).

- Personal history of CRC or colorectal polyps, or of inflammatory bowel disease and a
family history with a first-degree relative with CRC or colorectal polyps.

- Unable to speak English or Spanish

- Compliant with CRC screening (FOBT or FIT within the past year; flexible
sigmoidoscopy within past 5 years; colonoscopy within past 10 years)