Multi-level Approaches to Improve Colorectal Cancer Screening in Men and Women in Rural Michigan

Why is colorectal cancer (CRC) the focus of this study?

  • Excluding skin cancers, CRC is the third most common cancer among men and women in the United States (US). 147,950 new cases of CRC in US are expected I 2020.
  • Early detection of CRC leads to improved survival.
  • CRC screening has been shown to detection of CRC at early stage and save lives.
  • For average risk men and women (those without personal or family history of CRC or polyps and personal history of inflammatory bowel disease), it is more important to get screened for CRC with any accepted methods rather than a particular method.
  • Accepted methods include stool based methods (fecal immunochemical test or FIT, and stool-based DNA test, better known as Cologuard) and colonoscopy.
  • While physicians usually recommend colonoscopy, many patients (26-53%) actually prefer stool-based tests. Patients may not proceed with recommended CRC screening test, especially colonoscopy, if they are not recommended the test they prefer.

This study aims to assess best ways for practices to assess patient preference for CRC screening test and help them complete CRC screening.

  • This is a survey study: We will send surveys to men and women aged 50 to 75 years across 50 rural primary care practices across Michigan about their preference for CRC screening test.
  • We will interview physicians and staff regarding the best way to achieve the above aim, using various methods such as reminder letters, decision aid, physician review and staff training in shared decision making, and patient navigation.

What are the criteria for inclusion in the study?

Patients will be eligible to participate if they:

  1. are patients of one of the eligible rural primary care practices in Michigan
  2. are aged 50-75 years
  3. have not had CRC or colorectal polyp
  4. do not have genetic predisposition to colon cancer based on family history
  5. do not have a terminal illness (e.g. heart failure, stage 4 cancer) that would limit their life expectancy
  6. speak English; and
  7. consent to participate.

What is the long-term goal of the study?

The long-term goal of this study is to improve CRC screening rates of men and women aged 50-75 years in rural Michigan. We aim to see if the combined efforts of mailed reminder, decision aid, shared decision making by the physician and staff, and patient navigation lead to better patient adherence to CRC screening and ultimate, higher CRC screening rates. This would lead to higher detection of early CRC and colorectal polyps and thus, decreased mortality from CRC.