Data from A Randomized Controlled Trial of a Tailored Navigation and a Standard Intervention in Colorectal Cancer Screening

Abstract

<div>Abstract<p><b>Background:</b> This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer screening adherence and screening decision stage (SDS).</p><p><b>Methods:</b> Primary care patients (<i>n</i> = 945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (<i>n</i> = 312), Standard Intervention (SI) Group (<i>n</i> = 316), or usual care Control Group (<i>n</i> = 317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months.</p><p><b>Results:</b> The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (<i>P</i> = 0.001 and <i>P</i> = 0.001, respectively), but the two intervention groups did not differ significantly (<i>P</i> = 0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (<i>P</i> = 0.001 and <i>P</i> = 0.001, respectively), and the intervention group difference approached significance (<i>P</i> = 0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options.</p><p><b>Conclusions:</b> Both interventions had significant, positive effects on outcomes compared with usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS.</p><p><b>Impact:</b> Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes. <i>Cancer Epidemiol Biomarkers Prev; 22(1); 109–17. ©2012 AACR</i>.</p></div>