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Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination

Jane G. Zapka, ScD; Stephenie C. Lemon, PhD; Elaine Puleo, PhD; Barbara Estabrook, MSPH; Roger Luckmann, MD; and Stephen Erban, MD
[+] Article and Author Information

From University of Massachusetts, Worcester, Massachusetts.


Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Grant Support: By grant CA69653 from the National Institutes of Health.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jane G. Zapka, ScD, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Current Author Addresses: Drs. Zapka and Lemon: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Puleo: Department of Epidemiology and Biostatistics, Arnold House, University of Massachusetts School of Public Health, Amherst, MA 01003.

Ms. Estabrook: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Luckmann: Department of Family Medicine, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Erban: Department of Medicine, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655.

Author Contributions: Conception and design: J.G. Zapka, R. Luckmann, S. Erban.

Analysis and interpretation of the data: J.G. Zapka, S.C. Lemon, E. Puleo, R. Luckmann.

Drafting of the article: J.G. Zapka, S.C. Lemon, B. Estabrook.

Critical revision of the article for important intellectual content: J.G. Zapka, S.C. Lemon, R. Luckmann.

Final approval of the article: J.G. Zapka, S.C. Lemon, R. Luckmann, S. Erban.

Provision of study materials or patients: B. Estabrook.

Statistical expertise: S.C. Lemon, E. Puleo.

Obtaining of funding: J.G. Zapka, R. Luckmann.

Administrative, technical, or logistic support: B. Estabrook, S. Erban.

Collection and assembly of data: B. Estabrook.


Ann Intern Med. 2004;141(9):683-692. doi:10.7326/0003-4819-141-9-200411020-00009
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In this trial, a mailed video outreach strategy had no effect on the overall rate of colorectal cancer screening and did not increase screening with sigmoidoscopy. However, if the person did watch the video, screening with sigmoidoscopy increased significantly. In a secondary analysis (data not shown), the intervention significantly and positively increased screening by testing other than fecal occult blood testing only (that is, increased colonoscopy or sigmoidoscopy with or without fecal occult blood testing and colonoscopy or sigmoidoscopy alone). Thus, our video was a useful promotion tool among a subset of participants. The absence of an overall screening effect might be partly due to the video's emphasis on sigmoidoscopy. While guidelines (37) and a recent cost-effectiveness analysis (2) do not advocate use of one screening strategy over another, lower-endoscopy procedures, particularly colonoscopy, may reduce mortality the most (6467) and are increasingly viewed as most accurate by the public and providers (6870). In addition, many managed care payers and Medicare are reimbursing for screening with lower-endoscopy procedures. Thus, promoting screening colonoscopy may become a central goal in reducing colorectal cancer mortality, pending other technology developments.

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Summary for Patients

Using a Video To Teach Patients about Colorectal Cancer Screening

The summary below is from the full report titled “Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination.” It is in the 2 November 2004 issue of Annals of Internal Medicine (volume 141, pages 683-692). The authors are J.G. Zapka, S.C. Lemon, E. Puleo, B. Estabrook, R. Luckmann, and S. Erban.

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