The long-term objective of the proposed research submitted by the State University of New York at Stony Brook (SUNYSB) is to increase the rates of colorectal cancer screening (CRC) among women and men aged 50 and older. The specific aims of the research are to test the effectiveness of Targeted Telephone Counseling (TTC) and individualized Continuing Medical Education in increasing CRC screening among study women and men. The cost- effectiveness of these interventions will also be assessed. The SUNYSB project will target community women and men aged 50-75 who are identified through population sample telephone surveys. The samples of women and men will be drawn from five study communities on Long Island. The individualized Continuing Medical Education (CME) intervention will be limited to the primary care physicians of women and men in the study population. The SUNYSB project will test Targeted Telephone Counseling (TTC) aimed at the individual's stage of readiness to adopt CRC screening and barriers to their utilization of screening. The individualized CME intervention aimed at their physicians will involve mailed materials, telephone and in-office interventions. The in-office intervention is designed to improve the use of office systems, physician communication and behavioral counseling, and to develop skills of office staff in FOBT instructions, readings and tracking. Adjuncts to these major components will also address CRC risk communication and complete diagnostic evaluation following a positive FOBT. The research involves a factorial design to test the relative effects of TTC and of CME when applied alone and in combination on increasing CRC use. Women and men in each study town with regular physicians will be randomized to the TTC or control condition, and assigned to a CME intervention or control group by virtue of whether or not they reside in a CME intervention vs control County. Pre-and post-intervention telephone surveys will assess changes in women's and men's knowledge, beliefs and practices relating to CRC screening. Pre-and post-intervention surveys of physicians and chart audits will also be conducted to evaluate changes in physician knowledge, beliefs and practices related to CRC screening. The research focuses on the important question of how to motivate participation in CRC screening.
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