title: The Effectiveness of a Physician-Only and Physician-Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients.
abstract: BACKGROUND
  Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities.
  
  
  OBJECTIVE
  Our purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care.
  
  
  METHODS
  This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention.
  
  
  METHODS
  Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study.
  
  
  METHODS
  Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment.
  
  
  METHODS
  Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test.
  
  
  RESULTS
  The physician-patient intervention (n = 167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n = 183; 61.1 % vs.50.3 %, p = 0.008) and usual care (n = 153; 61.1 % vs. 34.0 % p = 0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p = 0.03) and (5.1 % vs. 2.0 %, p = 0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests.
  
  
  CONCLUSIONS
  Compared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA. ndolan@nmff.org.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Dolan
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ramirez-Zohfeld
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, USA.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: M Rosario
authors.initials: MR
authors.lastname: Ferreira
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Galanter
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Radosta
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Milton Mickey
authors.initials: MM
authors.lastname: Eder
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA.|Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, USA.|Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kenzie A
authors.initials: KA
authors.lastname: Cameron
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003142:Communication; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010353:Patient Education as Topic / Q000379:methods; D018579:Patient Selection; D010817:Physician-Patient Relations
keywords: colorectal cancer screening; health literacy; physician communication of preventive care; randomized trial