Prospective Study
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World J Gastrointest Oncol. Jul 15, 2014; 6(7): 257-262
Published online Jul 15, 2014. doi: 10.4251/wjgo.v6.i7.257
Patient prompting of their physician resulted in increased colon cancer screening referrals
Vu Le, Saqib Syed, Kenneth J Vega, Tushar Sharma, Mohammad F Madhoun, Nandakumar Srinivasan, Courtney W Houchen
Vu Le, Saqib Syed, Kenneth J Vega, Tushar Sharma, Mohammad F Madhoun, Nandakumar Srinivasan, Courtney W Houchen, Division of Digestive Disease and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Tushar Sharma, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Author contributions: Le V, Syed S contributed to the conception and design, analysis and interpretation of data, drafting of the article, critical revision of article for important intellectual content, final approval of the article; Vega KJ contributed to the analysis of data, critical revision of article for important intellectual content, final approval of the article; Sharma T and Madhoun MF contributed to the analysis and interpretation of the data, critical revision of article for important intellectual content, final approval of the article; Srinivasan N, Houchen CW contributed to the conception and design, analysis and interpretation of data, drafting of the article, critical revision of article for important intellectual content, final approval of the article.
Correspondence to: Kenneth J Vega, MD, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 1345, Oklahoma City, OK 73104, United States. kenneth-vega@ouhsc.edu
Telephone: +1-405-2715428 Fax: +1-405-2715803
Received: September 23, 2013
Revised: February 27, 2014
Accepted: June 18, 2014
Published online: July 15, 2014
Abstract

AIM: To determine whether a communication instrument provided to patients prior to their primary care physician (PCP) visit initiates a conversation with their PCP about colorectal cancer screening (CRC-S), impacting screening referral rates in fully insured and underinsured patients.

METHODS: A prospective randomized control study was performed at a single academic center outpatient internal medicine (IRMC, underinsured) and family medicine (FMRC, insured) resident clinics prior to scheduled visits. In the intervention group, a pamphlet about the benefit of CRC-S and a reminder card were given to patients before the scheduled visit for prompting of CRC-S referral by their PCP. The main outcome measured was frequency of CRC-S referral in each clinic after intervention.

RESULTS: In the IRMC, 148 patients participated, a control group of 72 patients (40F and 32M) and 76 patients (48F and 28M) in the intervention group. Referrals for CRC-S occurred in 45/72 (63%) of control vs 70/76 (92%) in the intervention group (P≤ 0.001). In the FMRC, 126 patients participated, 66 (39F:27M) control and 60 (33F:27M) in the intervention group. CRC-S referrals occurred in 47/66 (71%) of controls vs 56/60 (98%) in the intervention group (P≤ 0.001).

CONCLUSION: Patient initiated physician prompting produced a significant referral increase for CRC-S in underinsured and insured patient populations. Additional investigation aimed at increasing CRC-S acceptance is warranted.

Keywords: Colon cancer, Screening, Primary care, Physician patient relationship, Referral

Core tip: Colon cancer screening only performed in approximately 60% of Americans over 50 years old. Inadequate communication between patient and physician is a significant obstacle to obtaining appropriate screening, especially in the underinsured population. Patient initiated prompting of their primary care physician for colorectal cancer screening with colonoscopy increased referrals in both underinsured and insured patient groups.