title: Increasing referral rate for screening colonoscopy through patient education and activation at a primary care clinic in New York City.
abstract: Colorectal cancer could be prevented through regular screening. Individuals age 50 and older are recommended to get screened via colonoscopy. Because physician referral is a major predictor of colonoscopy completion, two low-cost, evidence-based interventions were tested to increase referrals by activating patients to self-advocate.
  
  
  
  This study compared the impact of a pre-visit educational handout that prompts patients to discuss colonoscopy with their physician with the handout plus brief counseling through exit interviews and chart reviews. The main outcome was physician referral.
  
  
  
  Medical charts were reviewed for eligibility: 130 control patients (Arm 1), 45 patients who received the educational handout and health counseling (Arm 2), and 50 patients who received only the handout (Arm 3). Colonoscopy referral rates increased from 24.6% in Arm 1 to 44.4% and 52.0% in Arms 2 and 3, respectively (p=0.001). The proportion of exit interview participants who discussed colonoscopy with their doctor increased from 68.8% in Arm 1 to 76.5% and 88.9% in Arms 2 and 3, respectively.
  
  
  
  Results indicate that both interventions are effective at increasing colonoscopy referrals.
  
  
  
  Results suggest that an educational handout alone is sufficient in prompting patient-initiated discussions about colonoscopy.
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: pathu.sriphanlop@mssm.edu.
authors.forename: Pathu
authors.initials: P
authors.lastname: Sriphanlop
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Marie Oliva
authors.initials: MO
authors.lastname: Hennelly
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Sperling
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villagra
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D003376:Counseling; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*
keywords: Cancer; Cancer screening; Colonoscopy; Colorectal cancer screening; Patient activation; Patient education; Quality improvement