Systems of support to increase colorectal cancer screening and follow-up rates (SOS): Design, challenges, and baseline characteristics of trial participants

Beverly B. Green, C. Y. Wang, Kathryn Horner, Sheryl L Catz, Richard T. Meenan, Sally W. Vernon, David Carrell, Jessica Chubak, Cynthia Ko, Sharon Laing, Andy Bogart

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Background: Screening decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Screening breakdowns arise from lack of uptake and failure to follow-up after a positive screening test. Objectives: Systems of support to increase colorectal cancer screening and follow-up (SOS) is a randomized trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design. Methods: The setting is a large nonprofit healthcare organization. In part-1 study, patients age 50-75 due for CRC screening are randomized to one of 4 study conditions. Arm 1 receives usual care. Arm 2 receives automated support (mailed information about screening choices and fecal occult blood tests (FOBT)). Arm 3 receives automated and assisted support (a medical assistant telephone call). Arm 4 receives automated, assisted, and care management support (a registered nurse provides behavioral activation and coordination of care). In part-2, study patients with a positive FOBT or adenomas on flexible sigmoidoscopy are randomized to receive either usual care or nurse care management. Primary outcomes are: 1) the proportion with CRC screening, 2) the proportion with a complete diagnostic evaluation after a positive screening test. Results: We sent recruitment letters to 15,414 patients and 4675 were randomized. Randomly assigned treatment groups were similar in age, sex, race, education, self-reported health, and CRC screening history. Conclusions: We will determine the effectiveness and cost effectiveness of stepped increases in systems of support to increase CRC screening and follow-up after a positive screening test over 2. years.

Original languageEnglish (US)
Pages (from-to)589-603
Number of pages15
JournalContemporary Clinical Trials
Volume31
Issue number6
DOIs
StatePublished - Nov 2010
Externally publishedYes

Keywords

  • Colorectal cancer
  • Health care research
  • Methods
  • Population
  • Randomized controlled trial
  • Screening

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology (medical)

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