Improving colon cancer screening in community clinics

Terry Davis*, Connie Arnold, Alfred Rademaker, Charles Bennett, Stacy Bailey, Daci Platt, Cristalyn Reynolds, Dachao Liu, Edson Carias, Pat Bass, Michael Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


BACKGROUND The authors evaluated the effectiveness and cost effectiveness of 2 interventions designed to promote colorectal cancer (CRC) screening in safety-net settings. METHODS A 3-arm, quasi-experimental evaluation was conducted among 8 clinics in Louisiana. Screening efforts included: 1) enhanced usual care, 2) literacy-informed education of patients, and 3) education plus nurse support. Overall, 961 average-risk patients ages 50 to 85 years were eligible for routine CRC screening and were recruited. Outcomes included CRC screening completion and incremental cost effectiveness using literacy-informed education of patients and education plus nurse support versus enhanced usual care. RESULTS The baseline screening rate was <3%. After the interventions, the screening rate was 38.6% with enhanced usual care, 57.1% with education, and 60.6% with education that included additional nurse support. After adjusting for age, race, sex, and literacy, patients who received education alone were not more likely to complete screening than those who received enhanced usual care; and those who received additional nurse support were 1.60-fold more likely to complete screening than those who received enhanced usual care (95% confidence interval, 1.06-2.42; P =.024). The incremental cost per additional individual screened was $1337 for education plus nurse support over enhanced usual care. CONCLUSIONS Fecal occult blood test rates were increased beyond enhanced usual care by providing brief education and nurse support but not by providing education alone. More cost-effective alternatives to nurse support need to be investigated. Cancer 2013;119:3879-3886.

Original languageEnglish (US)
Pages (from-to)3879-3886
Number of pages8
Issue number21
StatePublished - Nov 1 2013


  • colorectal cancer screening
  • community health clinics
  • fecal occult blood test
  • federally qualified health centers
  • literacy
  • low-income patients

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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