title: Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: results from a pragmatic cluster randomized controlled trial.
abstract: BACKGROUND
  Evaluation of the effectiveness of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website), distributed to patients by their family physician, in improving fecal occult blood test (FOBT) colorectal cancer screening rates.
  
  
  METHODS
  A pragmatic, two arm, cluster randomized controlled trial in Winnipeg, Manitoba, Canada (39 medical clinic clusters; 79 fee-for-service family physicians; 2,395 average risk patients). All physicians followed their standard clinical screening practice. Intervention group physicians provided a fridge magnet to patients that facilitated patient decision aid access. Primary endpoint was FOBT screening rate within four months.Multi-level logistic regression to determine effect of cluster, physician, and patient level factors on patient FOBT completion rate. ICC determined.
  
  
  RESULTS
  Family physicians were randomized to control (n = 39) and intervention (n = 40) groups. Compared to controls (56.9%; n = 663/1165), patients receiving the intervention had a higher FOBT completion rate (66.6%; n = 805/1209; OR of 1.47; 95% confidence interval 1.06 to 2.03; p < 0.02). Patient aid utilization was low (1.1%; 13/1,221) and neither internet nor telephone access affected screening rates for the intervention group. FOBT screening rates differed among clinics and physicians (p < 0.0001). Patients whose physician promoted the FOBT were more likely to complete it (65%; n = 1140/1755) compared to those whose physician did not (51.1%; n = 242/470; p < 0.0001; OR of 1.54 and 95% CI of 1.23 to 1.92). Patients reporting they had done an FOBT in the past were more likely to complete the test (70.6%; n = 1141/1616; p < 0.0001; 95% CI 2.51 to 3.73) than those who had not (43%; n = 303/705). Patients 50-59 years old had lower screening rates compared to those over 60 (p < 0.0001). 75% of patients completing the test did so in 34 days.
  
  
  CONCLUSIONS
  Despite minimal use of the patient aid, intervention group patients were more likely to complete the FOBT. Powerful strategies to increase colorectal cancer screening rates include a recommendation to do the test from the family physician and focusing efforts on patients age 50-59 years to ensure they complete their first FOBT.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  clinicaltrials.gov identifier NCT01026753.
authors.affiliation: Department of Family Medicine Research, Faculty of Medicine, University of Manitoba, 208 Baisinger Drive, Winnipeg R2N 4H7 MB, Canada. kclousto@cc.umanitoba.ca.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Clouston
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: Jeff
authors.initials: J
authors.lastname: Sisler
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.forename: Michelle
authors.initials: M
authors.lastname: Lobchuk
authors.forename: Susan
authors.initials: S
authors.lastname: McClement
authors.forename: Gary
authors.initials: G
authors.lastname: Crow
mesh_terms: D002170:Canada; D015179:Colorectal Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010361:Patients / Q000523:psychology; D010821:Physicians, Family
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