Armin Shahrokni Dr. Hee-Soon Juon May 2010 Johns Hopkins Bloomberg School of Public Health
Significance of Topic Age-Adjusted U.S. Death Rates and Trends SEER data 1975-2006
Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison . Lancet 2005 Five-year Relative Survival Rates Among Patients Diagnosed with CRC by Race and Stage at Diagnosis, United States, 1996-2004. *Colonoscopy is an effective screening measure *Earlier diagnosis will lead to better survival Significance of Topic
Significance of the Topic Rate of Adherence: Far from Ideal MMWR Morb Mortal Wkly Rep. 2008 Mar 14;57(10):253-8
Barriers to Access Provider Practices, Knowledge, Policies Patient Knowledge & Attitudes Failure to promote CRC screening/ colonoscopy Missed Visits Preventive Care Missed Opportunities @Sick Visits @Well Visits Health Belief Model Framework for CRC Screening Adherence
Trans-Theoretical Framework for CRC Screening Adherence
Primary aim: to assess the efficacy of the proposed intervention on patients’ adherence to CRC screening guideline (undergoing colonoscopy)
Null hypothesis: our proposed intervention will not have any impact on adherence rate.
Secondary aims: 1) to assess the change in patients’ perception toward CRC and CRC screening before and after the intervention (HBM). 2) to assess the change in behavioral staging of participants toward CRC screening
4 dimensions: beneficence, barriers, cues to action and self efficacy.
Total score 120 30 McQueen A , Tiro JA , Vernon SW . Construct validity and invariance of four factors associated with colorectal cancer screening across gender, race, and prior screening. Cancer Epidemiol Biomarkers Prev. 2008 Sep;17(9):2231-7 8 32 Self efficacy 4 16 Cues to action 10 40 Barriers 8 32 Beneficence Minimum score Maximum score Dimension
Dependent variable: getting colonoscopy within 3 months. /change in HBM survey score and behavioral staging.
Intervening Variables: age, education, income, gender, insurance, number of co-morbidities, BMI, smoking, residency status (home vs. nursing home), marital status, race/ethnicity
Patients hospitalized in Griffin Hospital Research nurse Assess eligibility Eligible patients Explain study and obtain verbal & written consent Enrolled patients Randomization allocation software Control group Intervention group HBM & TT survey Educational pamphlets from CDC regarding CRC, its risk and benefits of screening , ways of screening PROCESS ROAD MAP
CDC SCREEN FOR LIFE EDUCATIONAL PAMPHLETS CDC SCREEN FOR LIFE EDUCATIONAL PAMPHLETS
Research Flowchart Participants in intervention group Research nurse Griffin GI Department Try to schedule patients in their first preferred time Give the written instruction about timing of colonoscopy, preparation for colonoscopy for the day and night before the procedure, Direction to Griffin GI department contact numbers Obtain 3 time preferences for colonoscopy PROCESS ROAD MAP
Intervention Group GI Department One week after scheduled date Research Nurse Colonoscopy performed ? YES Call participant HBM survey END NO Call participant HBM survey Specific reason for declining colonoscopy Participant wants 2 nd appointment ? NO TTM survey YES Contact GI department Schedule patient Repeat steps after scheduling patient PROCESS ROAD MAP
Control group Research nurse 3 months post discharge Phone call Colonoscopy performed? YES All patients Participant answers the phone? NO Try 3 times in 2 weeks Participant answers the phone? NO YES NO HBM & TT survey Obtain contact info of Gastroenterologist who have done the procedure HBM survey Contact Gastroenterologist to verify the report END PROCESS ROAD MAP