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Automated Telephone Outreach With Speech Recognition to Improve Colorectal Cancer Screening: A Randomized Controlled Trial

50 Years
64 Years
Not Enrolling
Colorectal Cancer

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Trial Information

Automated Telephone Outreach With Speech Recognition to Improve Colorectal Cancer Screening: A Randomized Controlled Trial

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the
United States. Despite widespread dissemination of evidence-based guidelines recommending
CRC screening, a large proportion of eligible individuals do not undergo screening. A
variety of interventions have been tested to increase screening in primary care, but there
remains an urgent imperative to develop and evaluate cost-effective and widely applicable
approaches to promoting screening. In March 2005, Harvard Pilgrim Health Care, a large
non-profit HMO in New England, carried out an internally funded program to increase CRC
screening. The HMO randomized 80,000 members aged 50 to 64 years to receive automated
telephone outreach with speech recognition or usual care. The intervention entailed the
telephone engagement of members in a dialogue with a computer-programmed, responsive human
voice about the importance of CRC screening, the options for undergoing screening, and
encouragement to follow-up with their primary care physicians. The present study involves a
12-month follow-up of all eligible members randomized to intervention or usual care in March
2005, with assessment of the effect of the intervention on rates of CRC screening. This
study has important implications for increasing CRC screening. With health plans expanding
efforts to screen large populations for CRC and other malignancies, automated telephone
outreach with speech recognition can reach large numbers of individuals with educational and
reminder messages. It is important to know whether these efforts to promote screening are
effective in overcoming known disparities in screening for CRC. If proven effective and
cost-effective, this technology has the potential for widespread adoption and
population-wide improvements in CRC screening and other prevention-related behaviors, with
the ultimate public health goal of reducing the burden of suffering attributable to cancer
and its complications.

Inclusion Criteria:

- Age 50-64 at baseline

- Continuous enrollment in health plan

Exclusion Criteria:

- Prior request for exclusion from research or quality improvement

- No telephone number on file

- Enrolled in other telephone-based outreach program of the health plan

- Share household with another eligible member

- Evidence of colorectal cancer or polyps at baseline

- Evidence of prior screening at baseline such that screening is not due at time of

Type of Study:


Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention

Outcome Measure:

colorectal cancer screening

Outcome Time Frame:

one year

Safety Issue:


Principal Investigator

Steven R Simon, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Harvard Pilgrim Health Care


United States: Institutional Review Board

Study ID:




Start Date:

March 2005

Completion Date:

March 2006

Related Keywords:

  • Colorectal Cancer
  • Colon cancer
  • Prevention
  • Screening
  • Telephone
  • Colorectal Neoplasms



Harvard Pilgrim Health CareBoston, Massachusetts  02215