Research article

The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial

Carmen L Lewis^1,2 , Alison T Brenner² , Jennifer M Griffith² and Michael P Pignone^1,2

¹Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC, USA

²Cecil G Sheps Center for Health Services Research, Chapel Hill, NC, USA

author email corresponding author email

Implementation Science 2008, 3:32doi:10.1186/1748-5908-3-32

Published:	2 June 2008

Abstract

Background

We sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice.

Methods

We conducted a controlled trial comparing the proportion of intervention patients who received colon cancer screening with wait list controls at one practice site. The intervention was a mailed package that included a letter from their primary care physician, a colon cancer screening decision aid, and instructions for obtaining each screening test without an office visit so that patients could access screening tests directly. Major outcomes were screening test completion and cost per additional patient screened.

Results

In the intervention group, 15% (20/137) were screened versus 4% (4/100) in the control group (difference 11%; (95%; CI 3%;18% p = 0.01). The cost per additional patient screened was estimated to be $94.

Conclusion

A multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening.