Change in Colorectal Cancer Screening Decision Stage

Abstract

Abstract Introduction: Colorectal cancer screening (CRC) screening decision stage (SDS) is a measure of proximity to screening. Predictors of change in SDS have not been reported in the literature. Objective: To assess SDS change and predictors of SDS among primary care patients 50 to 74 years of age who are enrolled in a randomized, controlled trial of behavioral interventions designed to increase CRC screening. Methods: On a baseline survey, study participants reported on perceptions about CRC screening and SDS (i.e., decided to screen vs. had not decided to screen). Participants were randomized to one of three study groups: Control Group (usual care), Standard Intervention (SI) Group [mailed screening materials (i.e., informational booklet, a stool blood test kit, instructions for scheduling a screening colonoscopy, and a reminder)]; and a Tailored Navigation Intervention (TNI) Group (mailed screening materials tailored to baseline SDS and a navigation telephone call). TNI Group participants were asked to report current SDS, including current screening status, at navigation. We assessed change in SDS from baseline to navigation and performed multivariable analyses to identify predictors of SDS change. Results: Of 248 TNI Group participants, 205 (83%) received a navigation call. Background characteristics of these participants were as follows: white (76%), female (64%), aged 50–59 (67%), >high school education (52%), and married (62%). At baseline, 43 (21%) participants reported that they had not decided to screen, and 162 (79%) reported that they had decided to screen. At navigation, 55 (27%) participants reported a positive change in SDS (26 moved forward in SDS but did not screen and 29 screened). Participants who had not decided to screen at baseline were more likely to exhibit positive change in SDS than those who had decided to screen at baseline (63% and 17%, respectively, P < 0.0001). Among participants who had not decided to screen at baseline, only one reported actual screening. Of those participants who had decided to screen, 28 actually screened. Discussion: More than a quarter of participants reported a positive change in SDS in response to the mailed tailored intervention materials sent before the navigation call. Baseline SDS was a strong predictor of SDS change.