Research ArticleOriginal ResearchA

Offering Annual Fecal Occult Blood Tests at Annual Flu Shot Clinics Increases Colorectal Cancer Screening Rates

Michael B. Potter, La Phengrasamy, Esther S. Hudes, Stephen J. McPhee and Judith M.E. Walsh
The Annals of Family Medicine January 2009, 7 (1) 17-23; DOI: https://doi.org/10.1370/afm.934

Article Figures & Data

Figures

Tables

  • Table 1.

    Demographic Characteristics of Study Participants (N = 514) in the Control and Intervention Groups

    CharacteristicsControl (n=246)Intervention (n=268)P Value
    CRCS = colorectal cancer screening; DCBE = double-contrast barium enema; FOBT = fecal occult blood test; FS = flexible sigmoidoscopy.
    a 2-sample t test.
    b Pearson χ2 test.
    Age, mean (SD), years65.6 (7.4)63.7 (7.6).004a
    Female sex, %65.961.2.273b
    Ethnicity, %.142b
        African American6.15.6
        Asian/Pacific Islander56.148.1
        Latino25.235.8
        Non-Latino white9.87.8
        Other/unknown2.82.6
    Non-English primary language, %75.672.0.392b
    Economic indicator: insurance, %.638b
        Medicare43.540.3
        Medicaid37.038.4
        Uninsured17.920.5
        Other1.60.8
    Economic indicator: yearly income, mean (SD), $10,967 (6,377)9,785 (6,383).036a
    Health care access in the last year
        Primary care visits, mean (SD), No.6.0 (3.7)5.4 (3.5).091a
        One or more hospitalizations, %4.98.2.129b
        One or more emergency department visits, %7.310.4.214b
    Preintervention flu shot and CRCS status, %
        Received flu shot in last year68.769.8.792b
    Baseline status for CRCS tests, %
        FOBT in last 12 months36.235.4.863b
        FS in last 5 years9.810.5.795b
        DCBE in last 5 years1.61.1.621b
        Colonoscopy in last 10 years16.317.2.784b
  • Table 2.

    Preintervention and Postintervention Changes in Percentage of Study Participants Up-to-Date with Colorectal Cancer Screening in the Control and Intervention Groups

    CRCS StatusControl (n=246)Intervention (n=268)Between Group P Value
    CRCS=colorectal cancer screening.
    a Pearson χ2 test.
    b 2-sample Wilcoxon rank-sum test on the preintervention-postintervention difference scores.
    c McNemar test.
    CRCS up-to-date before influenza season (October 16, 2006), %52.954.5.711a
    CRCS up-to-date after influenza season (March 31, 2007), %57.384.3<.001a
    Percentage point change+4.4 (−0.7 to 9.7)+29.8 (23.7 to 36.0)<.001b
    Preintervention to postintervention P valuec.071<.001
  • Table 3.

    Postintervention Percentage of Study Participants Up-to-Date With Colorectal Cancer Screening According to Baseline Screening Status (Initially Up-to-Date or Initially Not Up-to-Date)

    Study ParticipantsControl No. (%)Intervention No. (%)P Valuea
    a Pearson χ2 test.
    Total patients initially not up-to-date116122
        Patients who became up-to-date24 (20.7)83 (68.0)<.001
    Total patients initially up-to-date130146
        Patients who remained up-to-date117 (90.0)143 (98.0)<.005
  • Table 4.

    Multivariate Logistic Regression Analysis of Predictors of Being Up-to-Date with Colorectal Cancer Screening at End of Influenza Season (March 31, 2007) for Study Participants (N = 514)

    Predictor VariablePatients Initially Overdue for CRCS (n=238) OR (95% CI)Patients Initially Up-to-Date for CRCS (n=276) OR (95% CI)
    CRCS=colorectal cancer screening; OR=odds ratio.
    a P <.001 for comparison with reference category.
    b P <.05 for comparison with reference category.
    Study arm, intervention (vs control)11.3 (5.8–22.0)a5.8 (1.5–22.0)a
    Age, 50–64 y (vs 65–79 y)0.8 (0.4–1.5)1.0 (0.3–3.4)
    Sex, male (vs female)1.1 (0.6–2.1)2.5 (0.7–9.3)
    Ethnicity, Hispanic (vs Asian)0.8 (0.4–1.6)0.4 (0.1–1.3)
    Other (vs Asian)0.5 (0.2–1.1)1.7 (0.2–15.9)
    Primary language, English (vs non-English)0.8 (0.4–1.8)2.0 (0.4–10.0)
    Insurance, insured (vs uninsured)1.4 (0.6–3.2)1.3 (0.3– 5.2)
    Income, above median (vs below)2.0 (1.1–3.8)b0.7 (0.2–2.0)
    Primary care visits, above median (vs below median)2.0 (1.0–3.7)b0.7 ( 0.2–2.3)

Additional Files

  • The Article in Brief

    Offering Annual Fecal Occult Blood Tests During Flu Shot Clinics Increases Colorectal Cancer Screening Rates

    Michael B. Potter , and colleagues

    Background Only about one-half of eligible adults aged 50 years and older report being up-to-date on screening for colorectal cancer. The home fecal occult blood test (FOBT) is the least expensive screening method, but there are often educational, linguistic, ethnic, social, or cultural barriers to its use. This study examines whether offering home FOBT tests during annual flu shot clinics is an effective way to increase rates of colorectal cancer screening.

    What This Study Found Offering home FOBT to eligible patients at a primary care-based annual flu shot clinic dramatically increases colorectal cancer screening rates among those in attendance. In this study of 514 patients at an annual flu shot clinic, screening rates increased by almost 30 percentage points among those offered an FOBT compared with an insignificant increase of 4 percentage points in screening among those who weren't offered the test.

    Implications

    • Annual flu shot activities provide an opportunity for nonphysician staff to offer FOBT to patients older than 50 years who need it at a time when they are already thinking about illness prevention.
    • Combining annual FOBT and flu shot activities could become an effective way to promote colorectal cancer screening in primary care settings, especially in communities and clinics where FOBT remains the primary screening option.

  • Annals Journal Club Selection:

    Jan/Feb 2009

    The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1

    How it Works

    In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.

    Article for Discussion

    • Potter MP, Phengrasamy L, Hudes ES, McPhee SJ, Walsh JME. Offering home fecal occult blood tests at flu shot clinics increases colorectal cancer screening rates. Ann Fam Med. 2009;7(1):17-23.

    Discussion Tips

    This clinical trial shows a dramatic effect of adding fecal occult blood testing to flu shot clinics. In addition to critiquing the article, it may be worthwhile to consider how the findings might be reinvented in your practice setting.

    Discussion Questions

    • What question is addressed by the article? How does the question fit with what already is known on this topic?
    • How does theory inform the intervention design?
    • How strong is the study design for answering the question?
    • How do the study methods compare with the CONSORT criteria for clinical trials?2 What adjustments in the criteria are necessitated by the randomization of clinic days rather than individuals?
    • What is the degree to which can the findings be accounted for by:
    1. How participants were selected? The exclusion criteria and drop outs? Are any biases likely to be important?
    2. How outcomes were measured?
    3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
    4. How information was interpreted?
    5. Chance?
  • What are the main findings? How large is the effect?
  • What do we learn from the secondary analyses of factors associated with variations in screening completion, and from the description of attempts to follow up patients with positive fecal occult blood tests? What factors affect interpretation of these findings that are less an issue with interpreting the main effects of the clinical trial?
  • How transportable are the findings to your clinical setting? What factors might affect this transportability?
  • What are some next steps for applying the findings or answering other questions that this study raises?

    • References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. http://annfammed.org/cgi/content/full/4/3/196.
    2. CONSORT Group. CONSORT: Consolidated Standards of Reporting Trials. http://www.consort-statement.org/. Accessed Oct 26, 2008.
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Subjects