title: Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.
abstract: BACKGROUND
  Screening decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Screening breakdowns arise from lack of uptake and failure to follow-up after a positive screening test.
  
  
  OBJECTIVE
  Systems of support to increase colorectal cancer screening and follow-up (SOS) is a randomized trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design.
  
  
  METHODS
  The setting is a large nonprofit healthcare organization. In part-1 study, patients age 50-75 due for CRC screening are randomized to one of 4 study conditions. Arm 1 receives usual care. Arm 2 receives automated support (mailed information about screening choices and fecal occult blood tests (FOBT)). Arm 3 receives automated and assisted support (a medical assistant telephone call). Arm 4 receives automated, assisted, and care management support (a registered nurse provides behavioral activation and coordination of care). In part-2, study patients with a positive FOBT or adenomas on flexible sigmoidoscopy are randomized to receive either usual care or nurse care management. Primary outcomes are: 1) the proportion with CRC screening, 2) the proportion with a complete diagnostic evaluation after a positive screening test.
  
  
  RESULTS
  We sent recruitment letters to 15,414 patients and 4675 were randomized. Randomly assigned treatment groups were similar in age, sex, race, education, self-reported health, and CRC screening history.
  
  
  CONCLUSIONS
  We will determine the effectiveness and cost effectiveness of stepped increases in systems of support to increase CRC screening and follow-up after a positive screening test over 2years.
authors.affiliation: Group Health Permanente, Seattle, WA 98101, United States. green.b@ghc.org
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
authors.forename: C Y
authors.initials: CY
authors.lastname: Wang
authors.forename: Kathryn
authors.initials: K
authors.lastname: Horner
authors.forename: Sheryl
authors.initials: S
authors.lastname: Catz
authors.forename: Richard T
authors.initials: RT
authors.lastname: Meenan
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.forename: David
authors.initials: D
authors.lastname: Carrell
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ko
authors.forename: Sharon
authors.initials: S
authors.lastname: Laing
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
mesh_terms: D000368:Aged; D000488:Allied Health Personnel; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009732:Nursing Care; D009741:Nursing Staff, Hospital; D009780:Occult Blood; D010349:Patient Compliance; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011786:Quality Control; D012042:Registries; D017010:Reminder Systems; D012107:Research Design; D018401:Sample Size; D012812:Sigmoidoscopy; D013689:Telephone