Does access to a colorectal cancer screening website and-or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake: results from a pragmatic cluster randomized coReportar como inadecuado




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BMC Cancer

, 14:263

Epidemiology, prevention and public health

Abstract

BackgroundEvaluation of the effectiveness of a patient decision aid nurse-managed telephone support line and-or colorectal cancer screening website, distributed to patients by their family physician, in improving fecal occult blood test FOBT colorectal cancer screening rates.

MethodsA pragmatic, two arm, cluster randomized controlled trial in Winnipeg, Manitoba, Canada 39 medical clinic clusters; 79 fee-for-service family physicians; 2,395 average risk patients. All physicians followed their standard clinical screening practice. Intervention group physicians provided a fridge magnet to patients that facilitated patient decision aid access. Primary endpoint was FOBT screening rate within four months.

Multi-level logistic regression to determine effect of cluster, physician, and patient level factors on patient FOBT completion rate. ICC determined.

ResultsFamily physicians were randomized to control n = 39 and intervention n = 40 groups. Compared to controls 56.9%; n = 663-1165, patients receiving the intervention had a higher FOBT completion rate 66.6%; n = 805-1209; OR of 1.47; 95% confidence interval 1.06 to 2.03; p < 0.02. Patient aid utilization was low 1.1%; 13-1,221 and neither internet nor telephone access affected screening rates for the intervention group. FOBT screening rates differed among clinics and physicians p < 0.0001. Patients whose physician promoted the FOBT were more likely to complete it 65%; n = 1140-1755 compared to those whose physician did not 51.1%; n = 242-470; p < 0.0001; OR of 1.54 and 95% CI of 1.23 to 1.92. Patients reporting they had done an FOBT in the past were more likely to complete the test 70.6%; n = 1141-1616; p < 0.0001; 95% CI 2.51 to 3.73 than those who had not 43%; n = 303-705. Patients 50–59 years old had lower screening rates compared to those over 60 p < 0.0001. 75% of patients completing the test did so in 34 days.

ConclusionDespite minimal use of the patient aid, intervention group patients were more likely to complete the FOBT. Powerful strategies to increase colorectal cancer screening rates include a recommendation to do the test from the family physician and focusing efforts on patients age 50–59 years to ensure they complete their first FOBT.

Trial registrationTrial registration number: clinicaltrials.gov identifier NCT01026753.

KeywordsColorectal cancer screening Fecal occult blood test Community-based family practice Community-based primary healthcare research Cluster randomized controlled trial Pragmatic Patient decision aid Integrated knowledge translation Knowledge exchange AbbreviationsCRCColorectal cancer

FOBTFecal occult blood test

FPFamily physician

ICCIntraclass correlation coefficient

PINPhysician integrated network

UPCONUniting primary care and oncology-urban primary care oncology network.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-14-263 contains supplementary material, which is available to authorized users.

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Autor: Kathleen Clouston - Alan Katz - Patricia J Martens - Jeff Sisler - Donna Turner - Michelle Lobchuk - Susan McClement - Gar

Fuente: https://link.springer.com/







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