Trial Information

Use of Novel Tailored Reminders in Rural Primary Care

Screening for colorectal cancer (CRC) remains severely underutilized. Although simple
reminders are modestly effective in enhancing preventive care utilization, they are not
widely utilized. Even if used widely, the effectiveness of simple reminders is limited,
leaving nearly half of patients without screening. One explanation for this is that simple
reminders do not address the barriers and resources of the patients and physicians they are
designed to prompt. In this study, we will examine the impact on CRC screening of a reminder
system that uses the physician as the message source and is tailored to the physician
screening preferences and patient-reported characteristics, CRC screening-related barriers,
status and CRC susceptibility. This intervention will be compared to a standard CRC health
education and screening reminder system.

Touch screen 'Healthy Living' computer kiosks will be placed in 16 Kansas Physicians Engaged
in Prevention Research (KPEPR) Network primary care practices. The kiosk program will screen
for eligible participants who are at least 50 years of age and not up-to-date with CRC
screening and guide eligible participants through a computerized Colorectal Cancer
Assessment (CRCA). Kiosk participants will be randomized into either a general CRC health
education + screening reminder message (GRM) (N=640) or a patient and physician-tailored CRC
+ screening reminder message (TRM) (N=640). Immediately upon completion of the CRCA, GRM
participants will receive a brief informational flyer with general CRC health education
messages and a reminder to get screened routinely for CRC. Participants in the TRM arm will
receive an informational flyer that contains messages that are tailored to patient CRC
screening barriers, preferences, and attitudes and physician screening preferences (guided
by CRC screening options that are available within the local community) in addition to a
reminder to get screened for CRC. A 90-day telephone follow-up will assess participant
compliance with CRC screening recommendations, participant discussion with their physician
regarding CRC screening, and patient satisfaction.

This study will use a novel patient- and physician- tailored messaging approach to promote
colorectal cancer screening utilization. This study will help to assess how a practice-based
computerized patient activation approach can effectively circumvent the "systems problems"
endemic in rural primary care and lay the groundwork for future computer-based primary care
intervention studies to help patients make informed health decisions and engage in healthy
lifestyle behaviors.