Implementation Intentions To Promote Colon Cancer Screening In Rural Primary Care
Kimberly K Engelman, Assistant Professor
Preventive Medicine And Public Healthuniversity Of Kansas Medical Center
Grant 5R01CA121016-02 from National Cancer Institute, IRG: CLHP
Abstract: Although colorectal cancer (CRC) is preventable and curable if detected early, a large portion of the population is not current with screening recommendations. Many unscreened individuals 50 years of age and older do not receive health care system prompts to promote adherence to test preparation or completion. This study will assess the efficacy of a novel prompting intervention based on the concept of "implementation intentions". The intervention will be delivered through a partnership between patients, rural primary care physicians, and trained CRC information specialists (CRC-IS) and will focus on the ´recalcitrant´ primary care population. A randomized design will test a comparison condition of a "no-partnership" system with generic information versus a "partnership" intervention system that specifically addresses each participants´ CRC screening "implementation intentions" (the "when," "where" and "how" screening details). The study will be conducted with 450 patients eligible for CRC screening and recruited while presenting for care in a set of Research Network affiliated primary care clinics. All participants who are not up-to-date on CRC screening will receive a baseline tablet PC-administered CRC assessment and a CRC screening report to discuss with their provider. Completion of CRC screening at 60 days post index visit will be assessed through follow-up phone calls. Those not completing CRC screening after receiving the in-office screening reminder (i.e., recalcitrant participants) then will be randomized to either C (comparison group-"no-partnership") or CPI2 (active intervention-CRC-IS/ physician/patient partnership and implementation intentions-based communication concepts). Physicians will receive informational fax sheets summarizing all participant phone calls. A 120-day post randomization follow-up telephone call will assess the effects of implementation intentions communications and perceived CRC screening barriers encountered. The primary outcome will be CRC screening adherence at 120 days. Secondary outcomes will assess 120-day perceived barriers and advancement in screening decisional stage. This intervention will provide information on the utility of embedding an "implementation intentions" based behavioral intervention for promoting CRC screening among initially non-adherent primary care patients
Project start date: 2007-09-01
Project end date: 2011-07-31
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Grants awarded to Kimberly K Engelman
Use Of Novel Tailored Reminders In Rural Primary Care
Kimberly K Engelman, Assistant Professor
University Of Kansas Medical Center Msn 1039 Kansas City, Ks 66160
Grant 5R21CA121907-02 from National Cancer Institute, IRG: HRDI
Abstract: Screening for colorectal cancer (CRC) remains severely underutilized. Although simple reminders are modestly effective in enhancing preventive care utilization, they are not widely utilized. Even if used widely, the effectiveness of simple reminders is limited, leaving nearly half of patients without screening. One explanation for this is that simple reminders do not address the barriers and resources of the patients and physicians they are designed to prompt. In this study, we will examine the impact on CRC screening of a reminder system that uses the physician as the message source and is tailored to the physician screening preferences and patient-reported characteristics, CRC screening-related barriers, status and CRC susceptibility. This intervention will be compared a standard CRC health education and screening reminder system. Touch screen Healthy Living computer kiosks will be placed in 16 Kansas Physicians Engaged in Prevention Research (KPEPR) Network primary care practices. The kiosk program will screen for eligible participants who are at least 50 years of age and not up-to-date with CRC screening and guide eligible participants through a computerized Colorectal Cancer Assessment (CRCA). Kiosk participants will be cluster randomized (by practice site) into either a general CRC health education + screening reminder message (GRM) (N=640) or a patient and physician-tailored CRC + screening reminder message (TRM) (N=640). Immediately upon completion of the CRCA, GRM participants will receive a brief informational flyer with general CRC health education messages and a reminder to get screened routinely for CRC. Participants in the TRM arm will receive an informational flyer that contains messages that are tailored to patient CRC screening barriers, preferences, and attitudes and physician screening preferences (guided by CRC screening options that are available within the local community) in addition to a reminder to get screened for CRC. A 90-day telephone follow-up will assess participant compliance with CRC screening recommendations, participant discussion with their physician regarding CRC screening, and patient satisfaction. This study will use a novel patient and physician tailored messaging approach to promote colorectal cancer screening utilization. This study will help to assess how a practice-based computerized patient activation approach can effectively circumvent the "systems problems" endemic in rural primary care and lay the groundwork for future computer-based primary care intervention studies to help patients make informed health decisions and engage in healthy lifestyle behaviors.
Keywords: physician, aging, arm, attitude, base, behavior, colorectal neoplasm, community, computer, health, health education, lifestyle, preference, prevention, satisfaction, touch, clinical research
Project start date: 2006-05-04
Project end date: 2008-03-31
5R21CA121907-02 (2007): $161450
1R21CA121907-01 (2006): $167301
Implementation Intentions To Promote Colon Cancer Screening In Rural Primary Care
Kimberly K Engelman, Assistant Professor
Preventive Medicine And Public Healthuniversity Of Kansas Medical Center
Grant 5R01CA121016-02 from National Cancer Institute, IRG: CLHP
Abstract: Although colorectal cancer (CRC) is preventable and curable if detected early, a large portion of the population is not current with screening recommendations. Many unscreened individuals 50 years of age and older do not receive health care system prompts to promote adherence to test preparation or completion. This study will assess the efficacy of a novel prompting intervention based on the concept of "implementation intentions". The intervention will be delivered through a partnership between patients, rural primary care physicians, and trained CRC information specialists (CRC-IS) and will focus on the ´recalcitrant´ primary care population. A randomized design will test a comparison condition of a "no-partnership" system with generic information versus a "partnership" intervention system that specifically addresses each participants´ CRC screening "implementation intentions" (the "when," "where" and "how" screening details). The study will be conducted with 450 patients eligible for CRC screening and recruited while presenting for care in a set of Research Network affiliated primary care clinics. All participants who are not up-to-date on CRC screening will receive a baseline tablet PC-administered CRC assessment and a CRC screening report to discuss with their provider. Completion of CRC screening at 60 days post index visit will be assessed through follow-up phone calls. Those not completing CRC screening after receiving the in-office screening reminder (i.e., recalcitrant participants) then will be randomized to either C (comparison group-"no-partnership") or CPI2 (active intervention-CRC-IS/ physician/patient partnership and implementation intentions-based communication concepts). Physicians will receive informational fax sheets summarizing all participant phone calls. A 120-day post randomization follow-up telephone call will assess the effects of implementation intentions communications and perceived CRC screening barriers encountered. The primary outcome will be CRC screening adherence at 120 days. Secondary outcomes will assess 120-day perceived barriers and advancement in screening decisional stage. This intervention will provide information on the utility of embedding an "implementation intentions" based behavioral intervention for promoting CRC screening among initially non-adherent primary care patients
Project start date: 2007-09-01
Project end date: 2011-07-31
1R01CA121016-01A2 (2007): $442786
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