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Grant Details

Grant Number: 3R01CA121125-05S2 Interpret this number
Primary Investigator: Green, Beverly
Organization: Group Health Cooperative
Project Title: Systems of Support (SOS) to Increase Colon Cancer Screening and Follow-Up
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Colorectal cancer screening (CRCS) decreases colorectal cancer mortality and incidence however, 40-60% of eligible adults are not screened at recommended intervals, and many have never had any type of CRCS. Screening failures occur from both lack of screening and breakdowns in follow-up of positive tests. Strategies for improving the uptake of CRCS typically focus on either patients or health care providers, without describing the infrastructure changes, or systems of support (SOS), that are required to implement and sustain these changes. We propose a two-part study using the Chronic Care Model to organize SOS. We will identify a cohort of Group Health patients aged 50 -75 years whose CRCS is not current according to national guidelines. In Part A: Subjects will be randomized to receive one of four interventions of stepwise increasing intensity of support: 1.Usual care (UC). 2.Automated support (UC+ mailed information, fecal occult cards (FOBT) and reminders, and access to a cancer screening hotline to discuss other screening options). S.Assisted support (UC+ automated + a medical assistant to record choice and assists patients in completing the choice via the resources already supplied or sending requests to the patient's physician). 4.Nurse care management support (UC + automated + assisted + a cancer screening nurse who manages patient care by clarifying patient CRCS intent, assessing procedural risk, ordering tests, and assists with completion of the action plan). In Part B: Patients with a positive FOBT or flexible sigmoidoscopy (colonoscopy needed) will be randomized to one of two follow-up intervention arms. A.UC (which at Group Health includes a registry and physician alerts) or B.Nurse care management (UC + cancer screening nurse who manages care after a positive test. Our study hypotheses are that: 1. increasing levels of SOS wil result in increasing CRCS rates and 2. care management by cancer screening nurses will increase follow-up rates after a positive test. The primary specific aims are: 1. To compare the effectiveness of each intervention condition on increasing CRCS rates 2. To compare the effectiveness of each intervention condition on follow-up after a positive screening test The secondary aims are: 3. To assess the effects of each intervention condition on participants' cognitive, affective, and social factors related to CRCS adherence and satisfaction with medical services 4. To compare utilization, costs, and incremental cost-effectiveness of each intervention condition

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Publications

Time to Screening in the Systems of Support to Increase Colorectal Cancer Screening Trial.
Authors: Wang CY, de Dieu Tapsoba J, Anderson ML, Vernon SW, Chubak J, Fuller S, Green BB
Source: Cancer Epidemiol Biomarkers Prev, 2014 Jun 2;null, p. null.
EPub date: 2014 Jun 2.
PMID: 24891548
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Psychological distress after a positive fecal occult blood test result among members of an integrated healthcare delivery system.
Authors: Laing SS, Bogart A, Chubak J, Fuller S, Green BB
Source: Cancer Epidemiol Biomarkers Prev, 2014 Jan;23(1), p. 154-9.
EPub date: 2013 Nov 12.
PMID: 24220914
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Uptake and positive predictive value of fecal occult blood tests: A randomized controlled trial.
Authors: Chubak J, Bogart A, Fuller S, Laing SS, Green BB
Source: Prev Med, 2013 Nov;57(5), p. 671-8.
EPub date: 2013 Sep 9.
PMID: 24029556
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An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial.
Authors: Green BB, Wang CY, Anderson ML, Chubak J, Meenan RT, Vernon SW, Fuller S
Source: Ann Intern Med, 2013 Mar 5;158(5 Pt 1), p. 301-11.
PMID: 23460053
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Nonparticipation in a population-based trial to increase colorectal cancer screening.
Authors: Green BB, Bogart A, Chubak J, Vernon SW, Morales LS, Meenan RT, Laing SS, Fuller S, Ko C, Wang CY
Source: Am J Prev Med, 2012 Apr;42(4), p. 390-7.
PMID: 22424252
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The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy.
Authors: Carter BL, Bosworth HB, Green BB
Source: J Clin Hypertens (Greenwich), 2012 Jan;14(1), p. 51-65.
EPub date: 2011 Nov 28.
PMID: 22235824
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Systems of support to increase colorectal cancer screening and follow-up rates (SOS): design, challenges, and baseline characteristics of trial participants.
Authors: Green BB, Wang CY, Horner K, Catz S, Meenan RT, Vernon SW, Carrell D, Chubak J, Ko C, Laing S, Bogart A
Source: Contemp Clin Trials, 2010 Nov;31(6), p. 589-603.
EPub date: 2010 Jul 30.
PMID: 20674774
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