• Nancy C Dolan, Vanessa Ramirez-Zohfeld, Alfred W Rademaker, M Rosario Ferreira, William L Galanter, Jonathan Radosta, Milton Mickey Eder, and Kenzie A Cameron.
• Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 18-200, Chicago, IL, 60611, USA. ndolan@nmff.org.
• J Gen Intern Med. 2015 Dec 1; 30 (12): 178017871780-7.

BackgroundPhysician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities.ObjectiveOur purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care.DesignThis study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention.ParticipantsPatients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study.InterventionIntervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment.Main MeasuresRates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test.Key ResultsThe physician-patient intervention (n = 167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n = 183; 61.1 % vs.50.3 %, p = 0.008) and usual care (n = 153; 61.1 % vs. 34.0 % p = 0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p = 0.03) and (5.1 % vs. 2.0 %, p = 0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests.ConclusionsCompared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.

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