Primary Source: A Randomized Controlled Trial of the Impact of Targeted and Tailored Interventions on Colorectal Cancer Screening, Ronald E. Myers, Randa Sifri, et al, CANCER; Published Online: September 24, 2007; Print Issue Date: November 1, 2007.

Secondary Source & CME:
Targeted Interventions May Improve Rates of Colorectal Cancer Screening¹

The Study

Despite widespread recommendations from organizations such as the US Preventive Services Task Force (USPSTF) and the American Cancer Society, colorectal cancer screening remains underutilized. rates remain lower than desired. For example, the USPSTF recommends that persons aged 50 years or older have an annual screening stool blood test and/or other alternative CRC screening test every 5 years, a double-contrast barium enema every 5 years, or a colonoscopy every 10 years. However, data from the 2003 National Health Interview Survey showed that only 16% of Americans reported having a stool blood test within the past year, 36% underwent some type of endoscopic screening within the past 5 years, and 42% had either stool blood test screening within the past year or endoscopy screening within the past 5 years.

Dr. Myers, interviewed by Medscape, explained the barriers to higher compliance with screenings:
The reality is that most primary providers have essentially decided that there are 2 options. Colonoscopy is the preferred option followed by SBT [stool blood test]. One of these two screening options is commonly used. This needs to be addressed in the real world of patients and clinicians, who have made their choices. Another barrier to screening is that the procedures are fairly complex and require preparation. Although it has been simplified, the traditional guaiac smear test for fecal blood requires a special diet for 48 to 72 hours before the test, with the avoidance of certain foods. A colonoscopy is even more involved, requiring a person to take a day off from work and bowel preparation beginning several days ahead of the test. The process is becoming easier, but the lack of convenience and ease of screening is still an obstacle.

It is, however, the third reason, that primary care clinicians often do not promote CRC screening as a major issue in their practice and have not been as strident as they should be, that is the focus of this study.

This study looked at the impact on compliance with colorectal cancer screening of targeted interventions.

Methodology (excerpted from abstract):

Results(excerpted from abstract):
Screening rates in study groups were 33% in the control group, 46% in the SI group, 44% in the TI group, and 48% in the TIP

Commentary

The literature is replete with recommendations to tailor compliance enhancements. Rarely, however, does one see a study based, as this one is, on protocols that appear appropriate for day-to-day clinical use.

While it is disappointing that this study found that the compliance increased by the same statistical increment in all intervention groups rather than being improved the most by the customized interventions, that the issue is being studied at all is heartening.

My own, also unproven bias is that the interventions should be tailored not to the disorder or treatment but to the specific patient or, more practically, specific groups of patients.

Footnotes

1. News Author: Roxanne Nelson, CME Author: Désirée Lie, MD, MSEd, release Date: October 1, 2007; Valid for credit through October 1, 2008. Credits Available: Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians; Nurses - 0.25 nursing contact hours -None of these credits is in the area of pharmacology [back]

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