Simultaneous Improvement in Colon Cancer Screening Rates and Patient-Centered Care
| Status: | Recruiting |
|---|---|
| Conditions: | Colorectal Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 50 - 75 |
| Updated: | 4/21/2016 |
| Start Date: | February 2015 |
| Contact: | Channing E Tate, MPH |
| Email: | channing.tate@ucdenver.edu |
| Phone: | 3037248985 |
At the University of Colorado Hospital primary care clinics, only 59% of eligible patients
are up to date with current colorectal cancer (CRC) screening. This is below the national
average of 65% and well below the healthy people 2020 goal of 70.5%. Several screening
methods exist to screen patients for CRC ranging from invasive (i.e., colonoscopy) to less
invasive (i.e., testing the stool for blood). Although choice between screening methods is
recommended, patients are not currently offered an unbiased choice and physicians generally
recommend only colonoscopy. Further, the investigators know from research that choice
increases screening rates. Unfortunately, many people do not follow through when only
colonoscopy is offered. However, participants in one study were nearly twice as likely to be
screened if they were offered a choice between colonoscopy and fecal occult blood testing
rather than being offered colonoscopy alone. Thus, in this project, the investigators aim to
examine the feasibility of incorporating a patient decision aid (DA) for patients in CRC
screening surveillance with the Ambulatory Health Promotion (AHP) using a pre/post design.
The investigators will answer the following questions: 1) Is it feasible to incorporate a DA
in the AHP protocol?; 2) Is it feasible to incorporate mailing patients a stool blood test?;
3) Does the DA change CRC screening decision quality, using proxy measures such as knowledge
and intent; and 4) Does the DA change the proportion of participants that complete a CRC
screening test? To answer these questions the investigators will compare survey responses
and CRC test type completed between two AHP CRC surveillance patients groups - those that
received usual care versus those that received the DA.
are up to date with current colorectal cancer (CRC) screening. This is below the national
average of 65% and well below the healthy people 2020 goal of 70.5%. Several screening
methods exist to screen patients for CRC ranging from invasive (i.e., colonoscopy) to less
invasive (i.e., testing the stool for blood). Although choice between screening methods is
recommended, patients are not currently offered an unbiased choice and physicians generally
recommend only colonoscopy. Further, the investigators know from research that choice
increases screening rates. Unfortunately, many people do not follow through when only
colonoscopy is offered. However, participants in one study were nearly twice as likely to be
screened if they were offered a choice between colonoscopy and fecal occult blood testing
rather than being offered colonoscopy alone. Thus, in this project, the investigators aim to
examine the feasibility of incorporating a patient decision aid (DA) for patients in CRC
screening surveillance with the Ambulatory Health Promotion (AHP) using a pre/post design.
The investigators will answer the following questions: 1) Is it feasible to incorporate a DA
in the AHP protocol?; 2) Is it feasible to incorporate mailing patients a stool blood test?;
3) Does the DA change CRC screening decision quality, using proxy measures such as knowledge
and intent; and 4) Does the DA change the proportion of participants that complete a CRC
screening test? To answer these questions the investigators will compare survey responses
and CRC test type completed between two AHP CRC surveillance patients groups - those that
received usual care versus those that received the DA.
Inclusion Criteria:
- Individuals that fall within the age range for CRC screening surveillance (age 50 to
< = 75 years) from AHP
- Are eligible for CRC screening surveillance from AHP
- Were seen in the last 18 months by a provider at one of the primary medical care
clinics from the University of: General Internal Medicine, Family Medicine, or the
Women's Integrated Services in Health clinic, and the individual's primary medical
care provider has provided approval for AHP CRC outreach to an AHP staff person, and
have no record of a colonoscopy within the last 10 years, flexible sigmoidoscopy or
double-contrast barium enema within the past 5 years, or FOBT within the past year.
Exclusion Criteria:
- Individuals that do not speak English
- Individuals that have limited cognitive function/developmental disabilities
- Individuals that have a personal or family history of CRC (previous adenomatous
polyp), and/or, have a signs and symptoms colonoscopy order from their primary care
physician
- Not eligible for CRC screening surveillance from AHP
- Have a terminal medical illness that would otherwise categorize them as inappropriate
candidates for CRC screening.
- These are: the individual must have any of the following noted in their EPIC EMR:
personal history of CRC, colectomy, colostomy, or ileostomy; currently prescribed
anti-coagulation medications (ReoPro (abciximab), Aggrenox (aspirin plus
dipryridamole), Persantine (dipyridamole), Integrillin (eptifibatide), Ticlid
(ticlopidine), Aggrastat (terofiban), Heparin, Coumadin (warfarin), Pradaxa
(dabigatran), Xarelto (rivaroxaban)); currently prescribed plavix (clopidogrel); on
chronic oxygen; have end-stage renal disease; have unstable angina; have
arrhythmia/atrial fibrillation; have cardiomyopathy; currently weighs >350 pounds;
have cystic fibrosis; and/or, are insured by the Colorado indigent care program
(CICP) or Medicaid-Old age pension, AARP Medicare/Secure Horizons (except PFFS),
Denver Health Managed Medicaid, Evercare; Kaiser (not the prescriber of origin),
Medicare Complete, New Medicaid, New CICP. Furthermore, dependent on the severity of
the condition, the following are gauged for exclusion criteria and noted in the AHP
CRC screening surveillance test notes to then inquire about appropriate candidacy for
a colonoscopy: diabetes mellitus (insulin, oral, or both), chronic obstructive
pulmonary disease, emphysema, reactive airway disease; chronic renal disease;
multiple sclerosis; seizure disorder; murmurs; hepatitis; human immunodeficiency
virus /acquired immunodeficiency syndrome ; congestive heart failure; coronary artery
disease; aortic aneurysm; history of coronary artery bypass graft; heart valve issues
(prolapse, regurgitation, etc.); tachycardia; bradycardia; history of myocardial
infarction.
We found this trial at
1
site
13001 E 17th Pl
Aurora, Colorado 80045
Aurora, Colorado 80045
(303) 724-5000
Phone: 303-724-8985
University of Colorado Anschutz Medical Campus Located in the Denver metro area near the Rocky...
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