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Improving colon cancer screening in community clinics
Author(s) -
Davis Terry,
Arnold Connie,
Rademaker Alfred,
Bennett Charles,
Bailey Stacy,
Platt Daci,
Reynolds Cristalyn,
Liu Dachao,
Carias Edson,
Bass Pat,
Wolf Michael
Publication year - 2013
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28272
Subject(s) - medicine , psychological intervention , colorectal cancer , family medicine , fecal occult blood , cancer screening , patient education , confidence interval , nursing , literacy , cancer , colonoscopy , economics , economic growth
BACKGROUND The authors evaluated the effectiveness and cost effectiveness of 2 interventions designed to promote colorectal cancer (CRC) screening in safety‐net settings. METHODS A 3‐arm, quasi‐experimental evaluation was conducted among 8 clinics in Louisiana. Screening efforts included: 1) enhanced usual care, 2) literacy‐informed education of patients, and 3) education plus nurse support. Overall, 961 average‐risk patients ages 50 to 85 years were eligible for routine CRC screening and were recruited. Outcomes included CRC screening completion and incremental cost effectiveness using literacy‐informed education of patients and education plus nurse support versus enhanced usual care. RESULTS The baseline screening rate was <3%. After the interventions, the screening rate was 38.6% with enhanced usual care, 57.1% with education, and 60.6% with education that included additional nurse support. After adjusting for age, race, sex, and literacy, patients who received education alone were not more likely to complete screening than those who received enhanced usual care; and those who received additional nurse support were 1.60‐fold more likely to complete screening than those who received enhanced usual care (95% confidence interval, 1.06‐2.42; P = .024). The incremental cost per additional individual screened was $1337 for education plus nurse support over enhanced usual care. CONCLUSIONS Fecal occult blood test rates were increased beyond enhanced usual care by providing brief education and nurse support but not by providing education alone. More cost‐effective alternatives to nurse support need to be investigated. Cancer 2013;119:3879–3886. © 2013 American Cancer Society.