Effects of genetic and environmental risk assessment feedback on colorectal cancer screening adherence.

Little is known about the impact of genetic and environmental risk assessment (GERA) feedback on colorectal cancer (CRC) screening. In a recently completed randomized trial, primary care patients received GERA feedback based on a blood test for genetic polymorphisms and serum folate level (GERA Group) versus usual care (Control Group). Subsequently, participants were offered CRC screening.

Increasing colon cancer screening in primary care among African Americans.

Background: The study aimed to determine the effect of preference-based tailored navigation on colorectal cancer (CRC) screening adherence and related outcomes among African Americans (AAs).

Methods: We conducted a randomized controlled trial that included 764 AA patients who were age 50 to 75 years, were eligible for CRC screening, and had received care through primary care practices in Philadelphia. Consented patients completed a baseline telephone survey and were randomized to either a Standard Intervention (SI) group (n = 380) or a Tailored Navigation Intervention (TNI) group (n = 384).

The effects of test preference, test access, and navigation on colorectal cancer screening.

Background: Little is known about how colorectal cancer screening test preferences operate together with test access and navigation to influence screening adherence in primary care.

Methods: We analyzed data from a randomized trial of 945 primary care patients to assess the independent effects of screening test preference for fecal immunochemical test (FIT) or colonoscopy, mailed access to FIT and colonoscopy, and telephone navigation for FIT and colonoscopy, on screening.

Results: Preference was not associated with overall screening, but individuals who preferred FIT were more likely to complete FIT screening (P = 0.

Cost-effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care.

Background: Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of a mailed standard intervention (SI) and tailored navigation interventions (TNIs) to increase CRC screening use in the context of a randomized trial among primary care patients.

Methods: Participants (n = 945) were randomized either to a usual care control group (n = 317), to an SI group (n = 316), or to a TNI group (n = 312).

Decision counseling and participation in a pancreas cancer registry.

Cancer registries play a vital role in research, as they provide important data that can be used to assess disease etiology and risk. Specialty registries can help to address the need for information on defined cancer types. However, achieving high rates of participation in such registries is problematic.

A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening.

Background: This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer screening adherence and screening decision stage (SDS).

Methods: Primary care patients (n = 945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n = 312), Standard Intervention (SI) Group (n = 316), or usual care CONTROL GROUP (n = 317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call.

Variation in colorectal cancer screening steps in primary care: basis for practice improvement.

No published research has assessed the specific steps that primary care practices actually take to carry out screening for colorectal cancer (CRC). A written survey was distributed to clinicians and staff at 15 primary care practices to determine whether they perceived that personnel in their practices performed a series of 4 steps associated with screening colonoscopy and 7 steps associated with stool blood test screening. For each discrete step, the percentage of respondents from each practice who indicated that a given step is performed in that practice was calculated along with the mean of practice percentages.

Measuring informed decision making about prostate cancer screening in primary care.

Purpose: To measure the extent of informed decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure.

Methods: Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification.

Race and response to colon cancer screening interventions.

Objective: We report race-related differences in response to behavioral interventions in colorectal cancer (CRC) screening.

Methods: From 2002 through 2005, a total of 1430 primary care patients (578 whites and 852 African Americans) from Jefferson Family Medicine Associates, a large primary care practice affiliated with Thomas Jefferson University, completed a baseline survey and were randomized to 1 of 4 groups, as follows: control (usual care), standard intervention (SI), tailored intervention (TI), or tailored intervention plus phone (TIP). The SI group received a targeted print intervention by mail.

A randomized trial of genetic and environmental risk assessment (GERA) for colorectal cancer risk in primary care: trial design and baseline findings.

Purpose: This paper describes an ongoing randomized controlled trial designed to assess the impact of genetic and environmental risk assessment (GERA) on colorectal cancer (CRC) screening.

Methods: The trial includes asymptomatic patients who are 50-79years and are not up-to-date with CRC screening guidelines. Patients who responded to a baseline telephone survey are randomized to a GERA or Control group.

Mediated decision support in prostate cancer screening: a randomized controlled trial of decision counseling.

Objective: This randomized trial was conducted to assess the impact of a mediated decision support intervention on primary care patient prostate cancer screening knowledge, decisional conflict, informed decision making (IDM), and screening.

Methods: Before a routine office visit, 313 male patients eligible for prostate cancer screening completed a baseline telephone survey and received a mailed brochure on prostate cancer screening. At the visit, participants were randomized to either an enhanced intervention (EI) or a standard intervention (SI) group.

Factors associated with colorectal cancer screening decision stage.

Objective: This paper reports on factors associated with colorectal cancer (CRC) screening decision stage (SDS) in screening-eligible primary care patients.

Methods: Baseline telephone survey data (i.e.

Reasons patients with a positive fecal occult blood test result do not undergo complete diagnostic evaluation.

Purpose: Screening for fecal occult blood reduces colorectal cancer mortality by identifying patients with positive results for complete diagnostic evaluation (CDE). CDE rates are suboptimal, however. We sought to determine common reasons for nonperformance of a CDE as recorded by the primary care physician.

Tailored navigation in colorectal cancer screening.

Background: Colorectal cancer (CRC) screening is underutilized. Effective methods to increase screening use are needed. This study sought to determine the impact of tailored navigation on CRC screening in primary care.

Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use.

Background: Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia.

Methods: The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention.

A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening.

Background: Colorectal cancer screening is underutilized. The objective of the current study was to determine whether targeted and tailored interventions can increase screening use.

Methods: A total of 1546 primary care practice patients completed a baseline telephone survey and were randomized to 4 study groups: control (387 patients), Standard Intervention (SI) (387 patients), Tailored Intervention (TI) (386 patients), or Tailored Intervention plus Phone (TIP) (386 patients).

Genetic and environmental risk assessment for colorectal cancer risk in primary care practice settings: a pilot study.

Purpose: The assessment of genetic variants and environmental exposures (i.e., genetic and environmental risk assessment) may permit individualized risk stratification for common diseases as part of routine care.

Effectiveness of complete diagnostic examination in clinical practice settings.

Background: Thorough follow-up of a positive fecal occult blood test (FOBT) result, or a complete diagnostic evaluation (CDE), is recommended as routine care on the basis of findings from colorectal cancer (CRC) screening trials. CDE involves either colonoscopy or the combination of flexible sigmoidoscopy and double contrast barium enema X-ray. However, little evidence outside clinical screening trial settings has been reported in the literature to support CDE performance.

Increasing access to clinical and educational studies.

In 2001, the National Cancer Institute (NCI) provided funds to support the Increasing Access to Clinical and Educational Studies (ACES) Project of the Thomas Jefferson University, Kimmel Cancer Center in Philadelphia. The ACES Project enabled the Center to engage in the systematic development of approaches for reducing cancer health disparities among African Americans in Philadelphia. This project brought together community partners, clinical partners, cancer prevention and control experts, and staff from an NCI-designated cancer center to develop and implement a community-based outreach education program, a special populations investigator (SPI) training program, and SPI pilot studies in cancer screening and clinical trials participation.

Preparing African-American men in community primary care practices to decide whether or not to have prostate cancer screening.

Background: This study was a randomized trial to test the impact of an informed decision-making intervention on prostate cancer screening use.

Methods: The study population included 242 African-American men from three primary care practices who were 40-69 years of age and had no history of prostate cancer. Participants completed a baseline survey questionnaire and were randomly assigned either to a Standard Intervention (SI) group (N=121) or an Enhanced Intervention (EI) group (N=121).

Behaviors used by men to protect themselves against prostate cancer.

This paper reports on behaviors men use to protect themselves against prostate cancer. Data were collected via a telephone or mailed survey from 353 men enrolled in two studies of prostate cancer screening. Respondents reported behaviors they used to protect themselves against prostate cancer, and responses were coded as conventional care, self-care, or nothing.

The effect of ethnicity and maternal birthplace on small-for-gestational-age deliveries to HIV-infected women.

Objective: To examine the relative role of ethnicity and maternal birthplace on small-for-gestational-age (SGA) deliveries of a cohort of mothers in New York who were infected with human immunodeficiency virus.

Methods: Medicaid claims and linked vital statistics records were examined for 2,525 singleton deliveries to HIV-infected women from 1993 through 1996. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of SGA delivery associated with ethnicity (i.