title: Patient education for colon cancer screening: a randomized trial of a video mailed before a physical examination.
abstract: 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.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  5 primary care practices in central Massachusetts.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
authors.forename: Jane G
authors.initials: JG
authors.lastname: Zapka
authors.forename: Stephenie C
authors.initials: SC
authors.lastname: Lemon
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.forename: Barbara
authors.initials: B
authors.lastname: Estabrook
authors.forename: Roger
authors.initials: R
authors.lastname: Luckmann
authors.forename: Stephen
authors.initials: S
authors.lastname: Erban
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014743:Videotape Recording