DESCRIPTION (provided by applicant):
Much of the research on risk communication has addressed the lay public's ability to interpret and act on numeric risk information. In contrast, community programs often use lay educators who share personal stories to convey information about risk. We propose a randomized, controlled trial to examine effects of Storytelling (ST) versus a Usual Care (DC), numeric form of communication on patient compliance for colorectal cancer screening (CRCS) referrals. The interventions to be compared are two distinct modalities, ST or DC, for conveying CRC risk and risk reduction delivered when a patient comes in for a clinic visit and referral. Patients in low-income, primarily Medicare/Medicaid funded clinics due for CRCS will be randomized to one of two groups to receive a two-step intervention. Step 1 is delivered prior to CRCS referral via video, presenting either (a) ST: a culturally rich story about a family with various cancer-related risky and healthy behaviors and screening patterns, teaching elements of CRC risk, or (b) UC: a risk assessment tool for providing the same CRC risk information, but with individual feedback on ratings of relative risk. Patients in both arms of study receive a discussion of CRC risk reduction and prevention and CRCS guidelines to complete Step 1. Patients proceed to their scheduled visit with a clinician (with reminder card), receive a referral, and schedule the recommended CRCS at front desk, Step 2 of the intervention includes receiving information about the prescribed CRCS procedure and prep, either as (a) ST: a personal story or (b) UC: a review of topical handouts. We will randomize 600 patients referred for screening (300 each arm). We have preliminary data demonstrating feasibility of gaining approximately 90% compliance from providers to refer patients for screening using a reminder card. An additional preliminary study shows a trend for greater impact on intent to screen using ST compared to UC. Main Hypothesis: In a low-income, primarily Medicare/Medicaid-funded clinic setting, patients will comply more with a CRCS referral when exposed to ST style of risk communication and follow-up than those exposed to UC communication and follow-up. Secondary Hypothesis: Patients exposed to ST will be more likely to express intent to screen than those exposed to UC. Identification and engagement with the story and perceptions of threat, fear and stress will be assessed as mediators. Findings will potentially inform effective primary care practice interventions for CRCS.
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