Using a Video To Teach Patients about Colorectal Cancer Screening

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The summary below is from the full report titled "Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination." It is in the 2 November 2004 issue of Annals of Internal Medicine (volume 141, pages 683-692). The authors are J.G. Zapka, S.C. Lemon, E. Puleo, B. Estabrook, R. Luckmann, and S. Erban.

What is the problem and what is known about it so far?

Colorectal cancer (cancer of the colon [large intestine] or rectum) is a common cause of cancer death in the United States. Screening helps patients by detecting abnormal growths in the colon (polyps) before they become cancer and by detecting cancer at an early, curable stage.

Recommended screening tests include fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and barium enema. Fecal occult blood testing uses a chemical reaction to find traces of blood in stool. A positive result on FOBT should lead to colonoscopy. Sigmoidoscopy involves looking into the rectum and lower colon through a flexible tube-shaped instrument. Colonoscopy uses a similar but longer instrument to look at the entire colon. Doctors can take samples of the colon (biopsies) and remove polyps during colonoscopy. Barium enema involves taking x-rays of the abdomen after inserting barium into a person's colon by enema. Barium appears white on x-ray. If x-rays indicate a lesion in the colon, follow-up testing with colonoscopy is necessary.

Experts recommend colon cancer screening for adults older than 50 years of age. However, less than one third of adults get screening. A possible explanation for the underuse of colorectal cancer screening is that busy doctors do not have enough time to teach their patients about screening. A previous study showed that the combination of a video viewed in a doctor's office, educational pamphlets, and reminders increased the use of colorectal cancer screening.

Why did the researchers do this particular study?

To see whether mailing patients a video about colorectal cancer screening before a doctor's visit would increase the number of patients who get colon cancer screening.

Who was studied?

938 patients age 50 to 74 years who were scheduled for a physical examination and were eligible for colorectal cancer screening.

How was the study done?

The researchers assigned patients at random to receive either a mailed video about colorectal cancer screening or usual care from their physicians. The video was 15 minutes long and focused on colorectal cancer screening with sigmoidoscopy.

What did the researchers find?

The rates of colorectal cancer screening were the same in patients who received the video and those who did not. However, patients who received the video were more likely to get sigmoidoscopy as part of their screening than patients who did not get the video.

What were the limitations of the study?

The patients in the study practices had high rates of colorectal cancer screening even before the study. The video might be more effective in practices with lower screening rates. In addition, the video focused on sigmoidoscopy, which is only one and not necessarily the preferred option for colorectal cancer screening.

What are the implications of the study?

A video about colorectal screening with sigmoidoscopy mailed to patients before a doctor's visit did not increase the rate of colorectal cancer screening, possibly because a large percentage of patients watched little or none of the video.