1. Development of Materials and Methods for Physician Delivered Patient Education on CRC screening using FIT
Pegah Hosseini-Carroll, Jill Hancock, Abhishek Seth, Connie Arnold, James Morris, Terry Davis
Section of Gastroenterology, Department of Medicine • LSU Health Shreveport
BACKGROUND
Colorectal cancer (CRC) is a leading cause of cancer mortality in the
United States. Screening is associated with a significant reduction in
mortality. Despite well-established recommendations, CRC screening
is underutilized especially in African Americans who have a higher risk
for CRC and higher rates of late stage clinical presentation as
compared to other groups. Eliminating racial disparities in health care
is a national priority.
Low literacy rates may also be a contributing factor to CRC screening
disparities. Individuals with lower literacy have less knowledge, more
negative attitudes and are at greater risk of not being screened.
African Americans and low-income patients are disproportionately
affected by low literacy. Evidence on how to best overcome health
literacy barriers in CRC screening is limited.
The fecal immunochemical test (FIT) has been proven effective for the
early detection of cancer. The American College of Physicians,
American Cancer Society, and other organizations, including the
United States Prevention Task Force have recommended CRC
screening for adults with different modalities, which include the FIT,
starting at age 50, unless the patient is African American or at higher
risk. FIT is easier to use than traditional fecal occult blood tests with
less restrictions and simpler instructions.
HYPOTHESIS
Physician-delivered health literacy patient education on CRC will
increase the FIT completion among patients cared for in safety
net settings.
ACKNOWLEDGEMENTS
• Grant received from the Christus Schumpert Foundation
• Department of Internal Medicine, Section of Gastroenterology, and
Ambulatory Care Medicine Clinic
• Drs. Davis and Arnold are supported in part by 1 U54 GM104940
from the National Institute of General Medical Sciences of the
National Institutes of Health which funds the Louisiana Clinical and
Translational Science Center.
OBJECTIVE
The primary objective of this study is to test the effectiveness of a
physician-directed health literacy intervention in improving CRC
screening with FIT.
PHYSICIAN RECRUITMENT &
TRAINING
 A GI fellow recruited interested Internal Medicine Residents. The
majority of those interested wanted to pursue Gastroenterology.
 All participating Medicine residents and GI fellows completed the
institutional IRB training and certification process and were
randomized by computer to study arm.
 Lead GI fellow created customized in-service training power points
for each study arm.
 Lead GI fellow and GI and health communication faculty
developed a 1-hour curriculum for each study arm and provided a
1-hour after hours in-service for each group.
 Residents in the Education arm were given an iPad mini with the
instructional patient YouTube video installed and easily accessible.
 Resident physicians, GI fellows, and study faculty will meet
monthly to ensure quality measures.
PARTICIPANT RECRUITMENT &
ENROLLMENT
 200 LSU Internal Medicine Clinic patients of participating resident
physicians will be enrolled; 100 in each study arm.
 Resident will screen list of their clinic patients and will contact
patients by phone and ask them if they are interested in
participating in the study.
 If the patient agrees, the resident will notify the research assistant
(RA) who will meet patient at clinic appointment.
 RA will screen patients for eligibility with 8 item questionnaire after
arrival for appointment.
 RA will consent eligible patients and privately administer the survey
and health literacy test.
STUDY INSTRUMENTS
Questionnaire
•Structured survey, administered orally by RA at patient enrollment
•21 items includes demographics and assessment of CRC and screening
knowledge, attitudes, and beliefs
•Items from validated questionnaires used previously by the authors
Health Literacy Assessment
•REALM (Rapid Estimate of Adult Literacy in Medicine) – most commonly used
literacy assessment in health care research
•Patients asked to read 66 health related words
•Raw scores can be converted into reading grade levels
YouTube Video
 Brief (<2 min) YouTube video developed and
produced by study authors.
 Gives simple step by step instructions and
motivational message.
InSure FIT kit
Simplified FIT Instructions
REALM Test Example Survey Questions
METHODS
The study was approved by the Louisiana State University Health Sciences
Center Shreveport and University Health Institutional Review Board
 Lab results checked daily by faculty.
 Resident enters results in EHR. Notifies patient by
mail if negative, by phone if positive.
CRC Educational Pamphlet
4th Grade Level3rd Grade Level
A two-arm resident physician education
intervention will be conducted in the University
Health Medicine Clinic between January &
December 2015. The two study arms are:
1.Enhanced standard care. During a
scheduled patient visit, physicians provide a
recommendation for CRC screening using
the FIT and give the FIT kit to the patient
with instructions to mail FIT to central lab in
stamped envelope.
2. Education arm. Physicians additionally provide literacy-directed
education which includes simplified FIT instructions, a literacy and
culturally appropriate pamphlet, and a YouTube instructional video.
The physicians will use the ‘teach back’ technique to confirm patient
comprehension of key steps in the testing process.
PATIENT MATERIALS