Dissemination of Colorectal Cancer Screening to Primary Care Physicians

The aim is to assess the efficacy of an intervention, academic detailing, a brief, frequently repeated educational program, on increasing recommendations for colorectal cancer screening among primary care providers by comparison to a service-as-usual control. The study is a stratified randomized clinical trial of primary care physicians, stratified by distinct urban communities in the New York metropolitan area. The primary outcome is colorectal cancer screening recommendations measured via medical audit at 12-month followup after randomization.

Study Overview

• Status: Completed
• Conditions: Colorectal Cancer
• Intervention / Treatment: Behavioral: Academic Detailing

Detailed Description

The purpose of the present study is to adapt and extend the use of academic detailing to the dissemination of colorectal cancer (CRC) screening findings and guidelines to primary care physicians practicing in selected geographic areas in New York City. Since improving implementation of cancer screening guidelines also involves compliance by patients in completing the recommended tests or examinations, we will also seek to assess knowledge, attitude and screening behaviors of patients visiting primary care practitioners in our sample. Our long-term goal is to reduce colorectal cancer mortality among ethnic and racial minorities, by influencing the screening behaviors of their primary care physicians.

The specific aims of the study are as follows:

• Aim 1. To test the hypothesis that an intervention, multi-component academic detailing, will increase the rate of physician CRC screening at 3and 6month postrandomization, compared to the rate observed in a serviceasusual control.
• Aim 2. To develop models predicting which physician offices are most and least likely to adopt the intervention, and to generate hypotheses about tailoring the dissemination of CRC screening guidelines to different physician subgroups.
• Aim 3. To conduct cost-effectiveness analysis comparing the incremental societal costs and effects (in lives saved, life-years saved, and quality-of-life-years saved) of the CRC intervention implemented in physicians' offices.

• Study Type: Interventional
• Enrollment (Actual): 264
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • Columbia University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Devote at least 50% of their practice to primary care
• Work in the study communities
• Are non-hospital based community practitioners
• Have no immediate plans to retire or to leave their practice.

Exclusion Criteria:

• Specialty physicians
• Intend to retire or otherwise leave practice over course of the study
• Other conditions that would preclude meaningful participation
• Not working in study communities

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Academic Detailing; The academic detailing intervention will involve multiple components some of which are standardized across physicians (i.e. self-learning packets, newsletters). Detailing will also be customized to each physician, although the frequency of the detailing visits will be routinized across all participants to reduce cost and to maximize its potential for dissemination.	Behavioral: Academic Detailing; The academic detailing intervention will involve multiple components some of which are standardized across physicians (i.e. self-learning packets, newsletters). Detailing will also be customized to each physician, although the frequency of the detailing visits will be routinized across all participants to reduce cost and to maximize its potential for dissemination.
No Intervention: Service-as-Usual; Control Arm

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Colorectal cancer screening recommendations	Up to 12 months from the time of randomization

Collaborators and Investigators

• Sponsor: Columbia University
• Collaborators: American Cancer Society, Inc.
• Investigators: Principal Investigator: Sherri Sheinfeld Gorin, PhD, Columbia University

Publications and helpful links

General Publications

• Honda K, Gorin SS. A model of stage of change to recommend colonoscopy among urban primary care physicians. Health Psychol. 2006 Jan;25(1):65-73. doi: 10.1037/0278-6133.25.1.65.

Study record dates

Study Major Dates

• Study Start: May 1, 2003
• Primary Completion (Actual): July 1, 2006
• Study Completion (Actual): September 1, 2006

Study Registration Dates

• First Submitted: February 26, 2007
• First Submitted That Met QC Criteria: February 27, 2007
• First Posted (Estimate): February 28, 2007

Study Record Updates

• Last Update Posted (Estimate): February 1, 2011
• Last Update Submitted That Met QC Criteria: January 28, 2011
• Last Verified: January 1, 2011

More Information

Terms related to this study

• Keywords: colorectal cancer screening; health disparities; primary care physicians; stratified randomized clinical trial
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms
• Other Study ID Numbers: AAAA6315