title: A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening.
abstract: 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. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months.
  
  
  RESULTS
  The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%,
  
  
  METHODS
  12%), was higher for intervention recipients than controls (P = 0.001 and P = 0.001, respectively), but the two intervention groups did not differ significantly (P = 0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and
  
  
  METHODS
  +23%) was significantly greater among intervention recipients than controls (P = 0.001 and P = 0.001, respectively), and the intervention group difference approached significance (P = 0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options.
  
  
  CONCLUSIONS
  Both interventions had significant, positive effects on outcomes compared with usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS.
  
  
  CONCLUSIONS
  Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 1014, Philadelphia, PA 19107, USA. ronald.myers@jefferson.edu
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.forename: Heather
authors.initials: H
authors.lastname: Bittner-Fagan
authors.forename: Constantine
authors.initials: C
authors.lastname: Daskalakis
authors.forename: Randa
authors.initials: R
authors.lastname: Sifri
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.forename: James
authors.initials: J
authors.lastname: Cocroft
authors.forename: Melissa
authors.initials: M
authors.lastname: Dicarlo
authors.forename: Nora
authors.initials: N
authors.lastname: Katurakes
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Andrel
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D011177:Postal Service / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods; D017010:Reminder Systems; D014481:United States