Interventions to Increase Colorectal Cancer Screening

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Colorectal cancer (CRC) is the third leading cause of cancer death in the United States with the majority of CRC diagnosed in those aged 50 or older. Prospective data indicate that annual fecal occult blood tests (FOBT) can decease mortality from CRC. The American Cancer Society recommends an annual FOBT and a flexible sigmoidoscopy every 5 years. Utilization of these tests is very low, ranging from 19% to 39%, especially among those who are 50 or older and most at risk for developing the disease. Tailored interventions have demonstrated significant increases in mammography use, and may be effective in the area of CRC screening as well. The purpose of this study is to compare the effectiveness of a tailored versus a non-tailored intervention designed to increase the use of FOBT and sigmoidoscopy, and to determine its effect on cognitive stage of behavior. The theoretical framework for this study was derived from the Health Belief and Transtheoretical Models. Institutional review board approval will be obtained before data collection. All instruments proposed in this study were previously tested for reliability and validity. Trained research assistants will contact members of a Midwest-based health maintenance organization (HMO), aged 56 or older and who have not had an FOBT in the last 15 months. Once eligibility criteria is verified, those who agree to participate with be randomized to one of three groups; 1) control, 2) tailored print communication, and 3) non- tailored print communication. Baseline data will be collected by telephone from a sample of 600 HMO members. Interventions will be mailed 2 weeks from the baseline interview, and post intervention interviews conducted 2 months from the intervention. Logistic regression will be conducted modeling the odds of having an FORT or sigmoidoscopy by intervention group. Those independent variables significant in bivariate analyses at p equal to or < .20 will be entered in to a separate logistic regression model to identify predictors of FOBT and sigmoidoscopy use. Results will be useful in testing tailored interventions to increase FOBT and sigmoidoscopy in managed care settings.