Screening for colorectal cancer has saved millions of lives, however, not everyone has access or is aware that other screening procedures exist. Allen Greiner, M.D., M.P.H., who is a member of The University of Kansas Cancer Center’s Cancer Control and Population Health program and also professor and director of the research division in the Department of Family Medicine, is developing methods to provide minority and low-income populations access to colorectal cancer screening.
“We wanted to try to better understand the barriers that keep people from following through on screening,” said Dr. Greiner in a recent news release. “In some of our earlier research, we found people were receptive to screening. Once they learned more about it, they wanted to have it done.”
In a recent study published in the American Journal of Preventive Medicine, Dr. Greiner’s team used “implementation intention” inquiries to understand what would help people get colorectal screening. These questions were based on a decision model of health behavior called the Precaution Adoption Process Model, which accounts for people with no knowledge concerning a health problem and for those who have decided not to participate in the behavior altogether.
These notions have been used to increase the rates of cervical cancer, to increase the levels of physical activity in kids and adults with low-income and also in people with addictions during withdrawal. This further helps researchers design strategies about when, where and how a health behavior will be performed (in this particular case, screening for colorectal cancer).
In the study, participants were aged over 50 and from a mix of African-American, Hispanic and Caucasian backgrounds. The participants were assigned to one of two groups: the first group received routine education regarding screening for colorectal cancer and were questioned about exercise, diet and healthy living. The second group received a group of implementation intention questions including:
- “To remind myself to call and set up my colonoscopy appointment, I will:”
- “The day before my colonoscopy, to remind myself to start taking the laxative medicines, I will:”
- “I will get a ride to my colonoscopy from:”
“Basically we walk them through a series of goal-setting exercises where they get really specific about how they were going to follow through on their screening and remember each step of the process,” said Dr. Greiner in the news release.
All participants had the touchscreen sessions at their doctor’s office waiting room and were given the option to choose to get either a fecal blood test or a colonoscopy.
Colonoscopy is considered the “gold standard” screening test for colon cancer screening, however, many patients don’t feel comfortable with the invasiveness of the method and also for the time that the preparation process involves. The stool test is less invasive, however, participants are informed during the implementation intention that a positive stool test will result in a colonoscopy.
Results revealed that compared to those who received education information only, those who answered the implementation intention questions had 1.91 higher odds of getting colorectal cancer screening.
“Sometimes people don’t realize how difficult it is to follow through on this kind of thing, and it seems like this is a virtual solution that helps both patients and doctors save time,” said Dr. Greiner in the news release. “We think it mentally prepares them a little more for the rigors of the process and helps them work through the potential problems of setting it up.”
Dr. Greiner also hopes that the success of the questions using the touchscreen-based approach could be used to address other health problems such as other types of cancer screenings. The method can be helpful to plan care approaches, with Dr. Greiner noting it could also aid in chronic diseases such as diabetes or to improve overall adherence to medication.
Dr. Greiner ‘s team is currently working on a similar study for the American Indian population, since only about 10% to 20% of this population has access to colorectal cancer screening.
“It’s the hope that this kind of thing could be integrated into a person’s electronic medical health records,” said Dr. Greiner in the news release. “ That way, people who are already at the doctor’s office can easily map out how they would go about getting colon cancer screening, they’ll probably take the time to get it done.”