Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination

2 November 2004 | Volume 141 Issue 9 | Pages 683-692

Background: Colorectal cancer screening is underused, and primary care clinicians are challenged to provide patient education within the constraints of busy practices.

Objective: To test the effect of an educational video, mailed to patients' homes before a physical examination, on performance of colorectal cancer screening, particularly sigmoidoscopy.

Design: Randomized, controlled trial.

Setting: 5 primary care practices in central Massachusetts.

Participants: 938 patients age 50 to 74 years who were scheduled for an upcoming physical examination, had no personal history of colorectal cancer, and were eligible for lower-endoscopy screening according to current guidelines.

Intervention: Participants were randomly assigned to receive usual care (n = 488) or a video about colorectal cancer, the importance of early detection, and screening options (n = 450).

Measurements: Baseline and 6-month follow-up telephone assessments were conducted. A dependent variable classified screening since baseline as 1) sigmoidoscopy with or without other tests, 2) another test or test combination, or 3) no tests.

Results: Overall screening rates were the same in the intervention and control groups (55%). In regression modeling, intervention participants were nonsignificantly more likely to complete sigmoidoscopy alone or in combination with another test (odds ratio, 1.22 [95% CI, 0.88 to 1.70]). Intervention dose (viewing at least half of the video) was significantly related to receiving sigmoidoscopy with or without another test (odds ratio, 2.81 [CI, 1.85 to 4.26]). Recruitment records showed that at least 23% of people coming for periodic health assessments were currently screened by a lower-endoscopy procedure and therefore were not eligible.

Limitations: The primary care sample studied consisted primarily of middle-class white persons who had high screening rates at baseline. The results may not be generalizable to other populations. The trial was conducted during a period of increased health insurance coverage for lower-endoscopy procedures and public media attention to colon cancer screening.

Conclusions: A mailed video had no effect on the overall rate of colorectal cancer screening and only modestly improved sigmoidoscopy screening rates among patients in primary care practices.

Editors' Notes Context Many patients who might benefit from colorectal cancer screening do not get screening. Time pressure may prevent physicians from fully educating their patients about colorectal cancer screening. Contribution In this randomized, controlled trial, an educational video about colorectal cancer screening mailed to patients before a primary care visit did not increase the rate of screening compared with usual care. Cautions The video focused on sigmoidoscopy rather than colonoscopy, and the study sample had a higher than average baseline rate of colorectal cancer screening. –The Editors

 

Author and Article Information

From University of Massachusetts, Worcester, Massachusetts.

Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Grant Support: By grant CA69653 from the National Institutes of Health.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jane G. Zapka, ScD, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Current Author Addresses: Drs. Zapka and Lemon: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Puleo: Department of Epidemiology and Biostatistics, Arnold House, University of Massachusetts School of Public Health, Amherst, MA 01003.

Ms. Estabrook: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Luckmann: Department of Family Medicine, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Erban: Department of Medicine, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655.

Author Contributions: Conception and design: J.G. Zapka, R. Luckmann, S. Erban.

Analysis and interpretation of the data: J.G. Zapka, S.C. Lemon, E. Puleo, R. Luckmann.

Drafting of the article: J.G. Zapka, S.C. Lemon, B. Estabrook.

Critical revision of the article for important intellectual content: J.G. Zapka, S.C. Lemon, R. Luckmann.

Final approval of the article: J.G. Zapka, S.C. Lemon, R. Luckmann, S. Erban.

Provision of study materials or patients: B. Estabrook.

Statistical expertise: S.C. Lemon, E. Puleo.

Obtaining of funding: J.G. Zapka, R. Luckmann.

Administrative, technical, or logistic support: B. Estabrook, S. Erban.

Collection and assembly of data: B. Estabrook.