TY - JOUR
T1 - A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans
AU - Vernon, Sally W.
AU - del Junco, Deborah J.
AU - Coan, Sharon P.
AU - Murphy, Caitlin C.
AU - Walters, Scott T.
AU - Friedman, Robert H.
AU - Bastian, Lori A.
AU - Fisher, Deborah A.
AU - Lairson, David R.
AU - Myers, Ronald E.
N1 - Funding Information:
This work was funded by the National Cancer Institute (RO1 CA 112223). We thank the survey respondents for their important contributions to this study. We hope this work honors the service of the US military Veterans, both women and men, who served in the Vietnam War and during the Vietnam era.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6
Y1 - 2021/6
N2 - Background: Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. Objectives: To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. Methods: Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. Results: After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). Conclusions: In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.
AB - Background: Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. Objectives: To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. Methods: Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. Results: After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). Conclusions: In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.
KW - Behavioral intervention
KW - Colorectal cancer screening
KW - Population-based
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U2 - 10.1016/j.cct.2021.106392
DO - 10.1016/j.cct.2021.106392
M3 - Article
C2 - 33823295
AN - SCOPUS:85103757065
SN - 1551-7144
VL - 105
JO - Contemporary Clinical Trials
JF - Contemporary Clinical Trials
M1 - 106392
ER -