Trial Information

Implementation Intentions to Promote Colon Cancer Screening in Rural Primary Care Practice

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 600 patients eligible for CRC
screening and recruited while presenting for care in a set of Research Network affiliated
primary care clinics, or patient contact information gathered from in-house chart reviews.
All participants who are not up-to-date on CRC screening, or not at high risk for CRC, will
receive a baseline tablet PC-administered CRC assessment, or a letter of invitation from
their PC physician to go online to the Healthy Living Kansas patient portal to complete the
assessment. Completion of CRC screening at 60 days post index visit will be assessed through
follow-up phone calls. Those not completing CRC screening after taking the assessment,(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.