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Translation of Colorectal Cancer Screening Guidelines: A System Intervention

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Trial Information

Translation of Colorectal Cancer Screening Guidelines: A System Intervention

Objectives: 1.To implement an electronic CRC screening event notification system
intervention to improve complete evaluation of patients with a positive FOBT at four of
eight VAMCs randomized to this intervention vs usual care.

2.To conduct a qualitative evaluation to identify implementation barriers and facilitators,
and to guide modifications of the CRC-ENS. 3.To conduct an outcome evaluation to determine
the effectiveness of the intervention to:

a. increase the proportion of patients with a positive FOBT receiving CDE. b. reduce the
time-lag between notification of a positive FOBT result and scheduling of a follow-up
endoscopic procedure. 4. To improve patient compliance with follow-up recommendations
through a combined scheduling/motivational telephone contact. 5. To assess VA primary care
providers' knowledge, beliefs, attitudes and practices regarding FOBT screening and

Methods: The CRC-ENS intervention employs a relatively simple alteration to the current
electronic mechanism for notifying the primary care provider (PCP) of when a positive FOBT
is recorded. With the CRC-ENS, this notification will be forwarded to the gastroenterology
(GI) clinic as well as the PCP. This notification at the GI clinic will set off a cascade
of events that would normally only be triggered by a consult request from the PCP. In this
translation study, eight participating VHA sites will be randomly assigned to either the
CRC-ENS intervention or comparison group. The proposed project will take two years to
complete. During the first project year, the participating sites will be recruited and
randomized. Pre-intervention change of awareness strategies will be initiated at all
intervention sites. The CRC-ENS intervention will be implemented in the second project
year, and formative evaluation (including two sets of focus groups) will be carried out
throughout the intervention period. Post-intervention data collection, outcome evaluation
and dissemination of results will be carried out in months 18-24.

Inclusion Criteria:

- VA Medical Centers with either CORI (Clinical Outcomes Research Initiative) or
electronic notes/descriptions documenting GI endoscopic procedures

Exclusion Criteria:

- VA Medical Centers without electronic GI procedure documentation

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention

Outcome Measure:

Change in rates and timeliness of FOBT positive follow-up.

Outcome Time Frame:

6 months

Safety Issue:


Principal Investigator

Linda L. Humphrey, MD MPH

Investigator Role:

Principal Investigator

Investigator Affiliation:



United States: Federal Government

Study ID:

CRT 02-059



Start Date:

August 2005

Completion Date:

May 2008

Related Keywords:

  • Colorectal Cancer
  • cancer
  • colonoscopy
  • mass screening
  • colorectal cancer
  • colorectal carcinoma
  • reminder systems
  • rectal cancers
  • colorectal tumor
  • guidelines
  • CRC secondary prevention
  • colorectal neoplasms
  • colonic neoplasms
  • colonic diseases
  • hemoccult testing
  • Colorectal Neoplasms



Durham VA Medical Center HSR&D COE Durham, North Carolina  27705
Carl T. Hayden VA Medical Center Phoenix, Arizona  85012
VA Eastern Colorado Health Care System, Denver Denver, Colorado  80220
VA Medical & Regional Office Center, White River White River Junction, Vermont  05009-0001
Southern Arizona VA Health Care System Tucson, Arizona  85723
Overton Brooks VA Medical Center Shreveport, Louisiana  71101-4295
Minneapolis Minneapolis, Minnesota  55417
Portland Portland, Oregon  97239-2964
VA Medical Center, Nashville Nashville, Tennessee  37212-2637