Interactive Computer Program or Brochure in Increasing Colorectal Cancer Screening Among African Americans (PACT)

Interactive Computer Program or Brochure in Increasing Colorectal Cancer Screening Among African Americans

RATIONALE: An interactive computer program may be more effective than a brochure in increasing colorectal cancer screening among African Americans. PURPOSE: This randomized clinical trial is studying an interactive computer program to see how well it works compared with a brochure in increasing colorectal cancer screening among African Americans.

OBJECTIVES: Compare rates of participation in fecal occult blood testing and endoscopic screening (colonoscopy or sigmoidoscopy) among African-Americans who receive an interactive computer intervention (ICI) versus a non-tailored colorectal cancer screening brochure. Examine mediators and moderators of intervention effectiveness as depicted in the conceptual model. OUTLINE: This is a multicenter study. Participants are stratified according to site, age (≤ 65 years old vs > 65 years old) and gender. Participants are randomized to one of two arms. Arm I (non-tailored colorectal cancer screening brochure): Participants undergo a baseline interview via telephone and receive a colorectal cancer screening brochure in the clinic prior to visit with healthcare provider. Participants then undergo telephone interviews at 1 week, 6 months, and 15 months. Arm II (interactive computer intervention [ICI]): Participants undergo a baseline interview via telephone and complete an ICI in the clinic prior to visit with healthcare provider. Participants then undergo telephone interviews at 1 week, 6 months, and 15 months.

Participants undergo a baseline interview via telephone and receive a non-tailored CRC screening brochure in the clinic prior to visit with healthcare provider. Participants then undergo telephone interviews at 1 week, 6 months, and 15 months.

Participants undergo a baseline interview via telephone and complete an interactive computer intervention in the clinic prior to visit with healthcare provider. Participants then undergo telephone interviews at 1 week, 6 months, and 15 months.

Patients receive written educational material about colorectal cancer and prompting to talk to their doctor about getting tested.

Self-reported colorectal cancer (CRC) screening adherence with medical record verification of screening test completion

Self-reported CRC discussion and screening test recommendation from provider on intervention/clinic visit date

Discussion of Fecal Occult Blood Test (FOBT), colonoscopy, and sigmoidoscopy is assessed. Participants report on whether or not an FOBT kit was given to them during this visit. Additionally, participants report on whether or not someone in the doctor's office made an appointment for a colonoscopy or sigmoidoscopy.

Provider documentation of CRC discussion and screening test recommendation on intervention/clinic visit date

Medical record documentation of discussion of FOBT, providing participant with an FOBT kit, discussion and/or ordering a colonoscopy, and discussion and/or ordering a sigmoidoscopy is assessed.

Changes in perceived risk, benefits to screening, barriers to screening, and self-efficacy for CRC screening are assessed.

For FOBT, colonoscopy, and sigmoidoscopy, stage of adoption measured as either precontemplation, contemplation, preparation, action, or maintenance.

Pre-intervention (baseline),1 week post-intervention, 6 months post-intervention, and 15 months post-intervention

Age, gender, marital status, education, health literacy, income, employment, insurance coverage, BMI, co-morbidities, family history of cancer, family or friend encouragement to have CRC screening, CRC knowledge, physician trust, fatalism views, and health temporal orientation are assessed.

Pre-intervention (baseline), intervention date, 1 week post-intervention, 6 months post-intervention, and/or 15 months post-intervention

Clinic site, participant's reason for health care provider visit, and prior recommendation(s) to do CRC screening are assessed.

Pre-intervention (baseline), 1 week post-intervention, 6 months post-intervention, and 15 months post-intervention

DISEASE CHARACTERISTICS: Currently being seen in the primary care clinics of Wishard Memorial Hospital (Indianapolis, IN), Roudebush Veterans Affairs Medical Center (Indianapolis, IN), IU Health Family Medicine Center (Indianapolis, IN) or Norton Louisville Primary Care Clinic (Louisville, KY) African-American who is currently non-adherent to screening guidelines, meeting all of the following criteria: No fecal occult blood test in the past 12 months No sigmoidoscopy in the past 5 years No colonoscopy in the past 10 years Patients with average and increased risk for colorectal cancer are eligible No personal history of colorectal cancer PATIENT CHARACTERISTICS: Participants must have a telephone English-speaking Able to read at a 5th grade reading level No medical condition that prohibits colorectal cancer screening PRIOR CONCURRENT THERAPY: See Disease Characteristics

Rawl SM, Christy SM, Perkins SM, Tong Y, Krier C, Wang HL, Huang AM, Laury E, Rhyant B, Lloyd F, Willis DR, Imperiale TF, Myers LJ, Springston J, Skinner CS, Champion VL. Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial. Prev Med. 2021 Apr;145:106449. doi: 10.1016/j.ypmed.2021.106449. Epub 2021 Feb 4.

Christy SM, Perkins SM, Tong Y, Krier C, Champion VL, Skinner CS, Springston JK, Imperiale TF, Rawl SM. Promoting colorectal cancer screening discussion: a randomized controlled trial. Am J Prev Med. 2013 Apr;44(4):325-329. doi: 10.1016/j.amepre.2012.11.032.