New strategies to improve screening rates for colorectal cancer in low-income populations

Since the colonoscopy was developed more than four decades ago, the screening procedure for colorectal cancer has undoubtedly saved millions of lives.

Although the test has been around for a long time, not everyone has access to it or the knowledge that other colon cancer screening tests exist.

K. Allen Greiner, M.D., M.P.H., member of The University of Kansas Cancer Center's Cancer Control and Population Health program and professor and director of the research division in the Department of Family Medicine is working on developing strategies to improve screening rates in low-income and minority populations.

"We wanted to try to better understand the barriers that keep people from following through on screening," said Dr. Greiner. "In some of our earlier research, we found people were receptive to screening. Once they learned more about it, they wanted to have it done."

Dr. Greiner and his team are using something called "implementation intentions" questions to determine what will help people get screened for colorectal cancer. The results were published in a recent issue of the American Journal of Preventive Medicine.

Implementation intention questions were used with the Precaution Adoption Process Model, a decision-based model of health behavior accounting for people who have no knowledge of a health issue and those who have decided against participating in the behavior altogether. These concepts have been used to help addicts going through withdrawal, increase cervical cancer screening and increase physical activity in low-income kids and adults.

This knowledge helps researchers design plans that detail the how, where and when a health behavior (in this case, colon cancer screening) will be performed.

For this study, participants were older than 50 (the normal age for when colon cancer screening is recommended) and were a mix of African-Americans, Hispanics and Caucasians. They were placed in one of two groups: One group was given standard education about colon cancer screening along with questions about diet, exercise and healthy living. The other group was given implementation intention questions such as:

"To remind myself to call and set up my colonoscopy appointment, I will:"

"The day before my colonoscopy, to remind myself to start taking the laxative medicines, I will:"

"I will get a ride to my colonoscopy from:"

"Basically we walk them through a series of goal-setting exercises where they get really specific about how they were going to follow through on their screening and remember each step of the process," said Dr. Greiner.

Both groups completed their informational sessions on touchscreens in the waiting room of their doctors' offices. They could choose to get either a colonoscopy or a less-invasive fecal blood test.

Though the colonoscopy is often thought of as the "gold standard" of colon cancer screening, many people still are not comfortable with the invasive test and the time-consuming preparation process. The stool test requires a stool sample, although participants who choose that option during the implementation intention questions are also told that a positive stool test will result in a colonoscopy.

So did these more pointed, specific questions help increase the number of people who got screened?

Yes - those who answered the implementation intention questions had 1.91 higher odds of getting screened than those who solely received educational information.

"Sometimes people don't realize how difficult it is to follow through on this kind of thing, and it seems like this is a virtual solution that helps both patients and doctors save time," said Dr. Greiner. "We think it mentally prepares them a little more for the rigors of the process and helps them work through the potential problems of setting it up."

He's also hoping that the success of the touchscreen-based questions could be used to address other health issues, including other types of cancer screenings. Dr. Greiner noted it could also be helpful in planning care for chronic diseases (like diabetes) or improving overall medication adherence.

Currently, Dr. Greiner and his team are working on a similar study tailored to the region's American Indian population. Only about 10 to 20 percent of American Indians in this region are screened for colorectal cancer, so increasing knowledge and awareness is vital.

Right now, it seems like helping people plan out their health action plan in a way that's personalized to them may at least increase colorectal cancer screening rates.

"It's the hope that this kind of thing could be integrated into a person's electronic medical health records," said Dr. Greiner. " That way, people who are already at the doctor's office can easily map out how they would go about getting colon cancer screening, they'll probably take the time to get it done."