Tailored Navigation in CRC Screening

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We propose to conduct a four-year study with six community-based primary care practices that are part of the Christiana Care Health System (CCHS) in Delaware. CRC screening use in the practices is limited,as it is elsewhere in the United States. The research team will identify individuals in the practices who are eligible for CRC screening and will randomly assign consenting participants who complete a baseline survey to one of three study groups: a Usual Care (Control) Group, Standard Intervention (SI)Group, or Tailored Navigation Intervention (TNI) Group. Control Group participants will receive usual care. SI Group participants will receive a standard intervention (a generic mailed CRC screening kit) and a mailed reminder. TNI Group participants will receive a tailored navigation intervention (a preference-based mailed CRC screening kit and patient navigation by telephone) and a mailed reminder. The CRC screening kit provided to the TNI Group will reflect the participant's preferred CRC screening strategy. "Navigation" refers to the process of guidingthe TNI Group participant towards test performance. Specific aims of the study are to: Determine intervention impact on patient CRC screening utilization. Determine intervention impact on CRC screening preference. Determine intervention impact on patient knowledge and perceptions about CRC screening. We hypothesize that the TNI Group will have significantly higher CRC screening use, increased preference for CRC screening, and more favorable perceptions about CRC screening than the SI and Control Groups. We also expect these outcomes to be significantly more pronounced in the SI Group than the Control Group. Data obtained from baseline survey, endpoint survey, and an endpoint chart audit will be used to assess study group differences. Finally, analyses will be performed to determine intervention cost-effectiveness related to CRC screening utilization.