The purpose of this study is to determine the effectiveness of a two-component
intervention, that combines academic detailing at the medical practice level and
distribution of decision aids at the patient level, on adherence to colorectal cancer
Colorectal cancer is the second most common cause of cancer death in the United States.
Early detection and intervention can significantly reduce morbidity and mortality from
colorectal cancer (CRC), and current guidelines recommend that asymptomatic adults over age
50 periodically obtain screening by one of several modalities (FOBT, sigmoidoscopy,
colonoscopy, or double contrast barium enema). However, CRC screening remains substantially
underutilized in the U.S., and more than half of all adults do not adhere to these
recommendations. This study was designed to increase CRC screening among health plan
members, and involves the collaboration of a major health insurer.
We are conducting a cluster-randomized trial in health practices in Georgia and Florida, to
test the effectiveness of a decision aid (video + brochures) for increasing adherence to CRC
screening guidelines. Thirty-two large group practices were recruited and randomized to
receive usual care (routine reminders) or an evidence-based decision aid intervention. In
each practice, patients between the ages of 52 and 75, without current CRC screening
history, were enrolled into the study.
In early 2007, we received a full HIPAA waiver that permitted us to send the decision aid
intervention to long-term non-responders in the intervention group, and to access claims
data for this group and the long-term non-responders in the usual care group. This
procedure will make it possible for us to learn more about the real-world impact of the
The intervention will continue for up to 2 years for still-unscreened participants. The main
outcome is receipt of an evidence-based modality of CRC screening according to the US
Preventive Services Task Force Guidelines (FOBT, flexible sigmoidoscopy, colonoscopy, or
double contrast barium enema).
Unique features of the proposed study include its potential to establish systems to increase
screening uptake that will help fulfill HEDIS requirements; improving our understanding of
how screening promotion interventions work in both White and Black populations;
collaboration with a community partner of the Emory Prevention Research Center, and forging
collaborative relationships between public health and health care researchers, and the
affected communities of health plans and health care providers.
- Ages 52-75
- Aetna Health Plan member
- Average risk for colorectal cancer
- Did not have colorectal cancer screening within guideline time frame (1 to 10 years,
depending on individual's age and type of screening)
- History of colorectal cancer, polyps, inflammatory bowel disease, upper or lower
gastrointestinal bleeding, cirrhosis, chronic obstructive pulmonary disease, cancer,
blindness, uncorrectable hearing loss, severe dementia, severe heart failure, severe
coronary artery disease
- Family history of colorectal cancer/polyps