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). The control group received usual care throughout the study. The SI group received a targeted intervention by mail (ie, screening invitation letter, informational booklet, stool blood test, and reminder letter). The TI group received the targeted intervention with tailored "message pages." The TIP group received the targeted intervention, tailored message pages, and a telephone reminder. Intervention group contacts were repeated 1 year later. Screening was assessed 24 months after randomization.


RESULTS
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 group. Screening was found to be significantly higher in all 3 intervention groups compared with the control group (odds ratio [OR] of 1.7 [95% confidence interval (95% CI), 1.3-2.5], OR of 1.6 [95% CI, 1.2-2.1], and OR of 1.9 [95% CI, 1.4-2.6], respectively), but did not vary significantly across intervention groups. Multivariate analyses demonstrated that older age, education, past cancer screening, screening preference, response efficacy, social support and influence, and exposure to study interventions were positive predictors of screening. Having worries and concerns about screening was found to be a significant negative predictor.


CONCLUSIONS
Targeted and tailored interventions were found to increase colorectal cancer screening use. However, additional research is needed to determine how to increase the effect of such interventions in primary care.
Myers
Ronald E
RE
Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. Ron.myers@mail.tju.edu
Sifri
Randa
R
Hyslop
Terry
T
Rosenthal
Michael
M
Vernon
Sally W
SW
Cocroft
James
J
Wolf
Thomas
T
Andrel
Jocelyn
J
Wender
Richard
R
D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008389:Marketing of Health Services / Q000379:methods*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D017010:Reminder Systems