An Interactive Video Doctor to Encourage Cancer Screening

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DESCRIPTION (provided by applicant): Cancer screening saves lives and routine screening for several cancers is recommended for men and women aged 50 and over. Cancer screening for women includes breast cancer screening, colorectal cancer screening and periodic cervical cancer screening (often less frequently than the woman has been receiving it). Cancer screening for men includes colorectal cancer screening and because of the controversy about prostate cancer screening, a shared decision making approach is recommended. Although screening is recommended, many individuals are not being screened and novel approaches to increasing rates of screening are needed. Conducting interventions in a primary care clinic setting is challenging. Patients come in with other medical problems, and there are time and system limitations. We propose developing a novel tool that will function within the system in a busy clinic setting, and will integrate information obtained from a particular patient with provider cues and will be efficient, will relieve the burden of time constraints and will be tailored to the individual patient. In response to the program announcement Decision Making in Cancer; Single Event Decisions and consistent with the R 21 funding mechanism, we plan to develop an innovative tool which will be designed to increase rates of cancer screening and discussions about cancer screening. This tool will be a multimedia interactive Video Doctor that will assess an individual's stage of change with respect to cancer screening and will give messages targeted to individual stage of change in a feasible and efficient manner. This tool is innovative in that 1) it will focus on all recommended cancer screening for a particular individual and 2) it will be tailored to an individual's stage of change and individual barriers to screening and 3) it has not been previously been tested in a primary care clinic setting to facilitate cancer screening and is thus a novel approach to increasing rates of cancer screening and discussions about cancer screening. The specific aims of the proposed study are as follows: 1. To develop a multi-component interactive Video Doctor intervention that includes: a) assessment of cancer screening behavior and stage of change, b) an interactive Video Doctor, and c) the generation of individualized provider cue sheets (Provider Alerts). 2. To pilot test the multi-component interactive Video Doctor intervention with 80 patients for feasibility and acceptability in a primary care setting. 3. In this pilot study of 80 patients, to assess intention to be screened, interest in screening and stage of change before and after the Video Doctor intervention. In a future study, we plan to conduct a randomized controlled trial to determine the effectiveness of a multi- component interactive Video Doctor intervention which includes assessment of stage of change and cancer screening, an interactive Video Doctor, and generation of individualized provider cue sheets (Provider Alerts) on three outcomes: 1) increasing rates of breast and colorectal cancer screening, 2) increasing participants' readiness to be screened for breast and colorectal cancer, and 3) increasing physician-patient discussions about screening for cervical cancer and prostate cancer. Appropriate cancer screening for women aged 50 to 70 includes breast cancer screening with mammography, colorectal cancer screening and periodic cervical cancer screening. Cancer screening for men includes colorectal cancer screening and because prostate cancer screening is controversial, a shared decision making approach is recommended. There is a great need for effective interventions to improve rates of cancer screening and we propose developing a multi-component interactive Video Doctor that will be used to increase rates of age appropriate cancer screening. We will then pilot test it in a primary care clinic setting with 80 individuals to assess intention to ask providers about screening and interest in screening before and after the intervention. In a future study, we will test the intervention in a randomized clinical trial to determine its effectiveness in increasing rates of cancer screening and in increasing discussions about cancer screening. Should the intervention be successful, it can be used in many other settings in order to increase rates of cancer screening.