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Health Care Provider-Directed Intervention to Increase Colorectal Cancer Screening Among Veterans: Results of a Randomized Controlled Trial

From the Veterans Affairs Midwest Center for Health Services and Policy Research, Hines; Veterans Affairs Chicago Health Care System; Departments of Medicine, Psychiatry, and Preventive Medicine, Center for Healthcare Studies, and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL; Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA; and Medical University of South Carolina, Charleston, SC

Address reprint requests to M. Rosario Ferreira, MD, MAPP, 676 N St Clair St, Ste 1400, Chicago, IL 60611; e-mail: mr-ferreira{at}northwestern.edu

PURPOSE: Colorectal cancer screening is the most underused cancer screening tool in the United States. The purpose of this study was to test whether a health care provider–directed intervention increased colorectal cancer screening rates.

PATIENTS AND METHODS: The study was a randomized controlled trial conducted at two clinic firms at a Veterans Affairs Medical Center. The records of 5,711 patients were reviewed; 1,978 patients were eligible. Eligible patients were men aged 50 years and older who had no personal or family history of colorectal cancer or polyps, had not received colorectal cancer screening, and had at least one visit to the clinic during the study period. Health care providers in the intervention firm attended a workshop on colorectal cancer screening. Every 4 to 6 months, they attended quality improvement workshops where they received group screening rates, individualized confidential feedback, and training on improving communication with patients with limited literacy skills. Medical records were reviewed for colorectal cancer screening recommendations and completion. Literacy level was assessed in a subset of patients.

RESULTS: Colorectal cancer screening was recommended for 76.0% of patients in the intervention firm and for 69.4% of controls (P = .02). Screening tests were completed by 41.3% of patients in the intervention group versus 32.4% of controls (P = .003). Among patients with health literacy skills less than ninth grade, screening was completed by 55.7% of patients in the intervention group versus 30% of controls (P < .01).

CONCLUSION: A provider-directed intervention with feedback on individual and firm-specific screening rates significantly increased both recommendations and colorectal cancer screening completion rates among veterans.

Supported by grant No. PCI 99-158 from the Health Services Research Division of the Department of Veterans Affairs and by grant No. R01 CA86424-01A2 from the National Cancer Institute. M.R.F. is supported by a Research Career Development Award from the Health Services Research and Development Service of the Department of Veterans Affairs (grant No. RCD-01005-1) and by the Coleman Foundation.

Presented in part at the Veterans Affairs Health Services Research and Development’s 22nd National Meeting, Washington, DC, March 9-11, 2004; at the 28th Annual Meeting of the American Society for Preventive Oncology, Bethesda, MD, March 14-16, 2004, Bethesda, MD; at the 105th Annual Meeting of the American Gastroenterological Association, New Orleans, LA, May 15-20, 2004; and at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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