ONS Connections: Computer-tailored intervention increases colon cancer screening in low-income black patients

PHOENIX—A computer-tailored intervention was more effective than a brochure at increasing the completion of fecal occult blood tests and moving low-income black patients toward action, according to research presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

Colorectal cancer (CRC) is the third most common cancer affecting men and women, with African Americans having the highest incidence and mortality of all racial/ethnic groups. Regular screening reduces incidence and mortality from colorectal cancer. Cancer can be detected early by some screening tests, while other tests remove adenomatous polyps to prevent cancer. Approximately 50% of deaths from CRC could be reduced if eligible individuals were screened based upon current guidelines, reported Susan Rawl, PhD, RN, FAAN, during a presentation of the research at the ONS Connections meeting.

This study sought to address the urgent need to develop effective approaches to increase screening in low-income black patients. The researchers hypothesized that different approaches would yield different results in the proportions of patients who completed fecal occult blood tests or colonoscopy and in the proportions that moved forward in stage of adoption for these tests.

The researchers aimed to use interactive computer-tailored interventions, which have been shown to promote positive health behaviors by delivering individualized information and counseling to patients, enabling them to control how often information is presented and to respond to it.

This study randomly assigned 693 black primary care patients to either a computer-tailored colorectal cancer screening intervention (n=335) or to a non-tailored American Cancer Society colorectal cancer screening brochure (n=358). The patients were interviewed by phone at baseline and 6 months later. The interventions were delivered to the patients before they visited their primary care providers.

The fecal occult blood test was completed by 12.5% of those who received the computer-tailored intervention and by 7.3% of those who received the brochure intervention. Colonoscopies were completed by 18.5% of the patients in the computer groups and by 14.0% of those in the brochure group, which was not a significant difference between the interventions. While more patients in the computer intervention group moved forward toward adopting the fecal occult blood test (28.4% vs 20.8% in the brochure group), both groups had similar forward movement toward colonoscopy (38.5% in the computer group vs 36.8% in the brochure group).

“The computer-tailored intervention was more effective for increasing screening rates with FOBT (p=.02) and any screening test (p=.01) than the non-tailored brochure,” said Rawl. “Despite significant intervention effects, more than three-fourths (78%) of African American patients remained unscreened at 6 months. More comprehensive approaches that simultaneously target patients, families, providers, and healthcare systems may be needed,” she concluded.
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