Project Overview +

This study tests interventions aimed to increase colorectal cancer (CRC) screening. Callers over age 50 to the Cancer Information Service (CIS) receive a brief educational message delivered by an information specialist followed by mailed untailored and tailored print materials.

Aims +

Aim 1. Design, implement, and evaluate a proactive psychoeducational intervention to promote colorectal cancer screening using fecal occult blood tests (FOBT) and sigmoidoscopy.

Aim 2. Determine which subgroups benefit most from the proposed interventions.

Aim 3. Test the efficacy and cost-effectiveness of tailored print to promote behavior change.

Participants +

4,014 callers to NCI's Cancer Information Service over age 50 who have not been completed colorectal cancer screening.

Intervention +

At the end of usual care services, callers to NCI's Cancer Information Service (CIS) are invited to learn more about colorectal cancer screening. Eligible participants complete a baseline survey, receive a brief educational message delivered by a CIS informational specialist, and then are randomized to receive by mail, one of the four following sets of colorectal cancer screening materials:

  • a single untailored print communication (SU)
  • a single tailored print communication (ST)
  • four tailored print communications spanning 12 months, tailored on baseline data (MT)
  • four tailored print communications spanning 12 months, with retailoring of print materials based on updated 6-month data (MRT)

Tailored print materials test for efficacy in promoting colorectal cancer (CRC) screening (fecal occult blood test [FOBT], flexible sigmoidoscopy, or colonoscopy). All participants complete baseline interviews at the end of their usual service calls to the CIS, as well as short-term (6-month) and longer-term (14-month) telephone follow-up interviews.

Findings +

Consistent with the main hypothesis of this trial, a significant linear trend across the SU, ST, MT, and MRT groups was found at 14 months (42%, 44%, 51%, and 48%, respectively, p = 0.05). Only for MT was there a significant difference compared with SU (p = 0.03) for the sample as a whole, while no differences were found for MT vs. MRT at 14 months.

Significant moderator effects in the predicted direction were found among females, younger participants, and among those with a history of CRC screening, all of which involved the SU vs. MT MRT comparisons. Only among younger participants (ages 50-59) was there a difference between SU vs. ST at 14 months.

Conclusion +

Given these results, we conclude from this trial the following:

  • The MRT intervention failed to show added benefit beyond the MT intervention.
  • The significant intervention effects involving the MT and MRT conditions can be explained by tailoring and/or the longitudinal nature of both interventions.
  • The most compelling evidence in support of tailoring was found for the ST condition among younger participants, where a significant need for interventions exists at the national level.