El Proyecto de Salud Colorectal, The Colorectal Health Project

In the United States, colorectal cancer is the second-leading cause of cancer-related deaths. Approximately 50,000 people die from colorectal cancer each year. Incidence rates are lower among Hispanics than non-Hispanic whites; however, in comparison with non-Hispanic whites, Hispanics are less likely to be diagnosed with localized colorectal cancer and more likely to be diagnosed with the disease in later stages.

Screening can detect colorectal cancer at an early stage when treatment is more likely to be successful. Further, the detection and removal of polyps can prevent colorectal cancer from developing. The U.S. Preventive Services Task Force recommends regular screening beginning at age 50 and continuing until age 75 using high-sensitivity fecal occult blood testing (FOBT), including fecal immunochemical testing (FIT), sigmoidoscopy, or colonoscopy. Interventions designed to promote colorectal cancer screening are needed to reduce the incidence of mortality among Hispanics residing in the United States.

This program uses intervention approaches recommended by the Community Preventive Services Task Force: small media interventions (Colorectal Cancer Screening), one-on-one education interventions (Colorectal Cancer Screening), client reminder interventions (Colorectal Cancer Screening) and multicomponent interventions (Colorectal Cancer Screening).

-- Half-day for the promotor training
-- 15–20 minutes per patient to review the chart, assemble and send mailing, and track results
-- 10 minutes for each telephone reminder
-- 2 hours per patient for home visit (including attempts)

The intervention is intended for Hispanic adults aged 50–79 who have not had a recent colorectal screening exam.

The intervention is designed to be implemented in community health care clinics.

Required resources to implement the program include the following:

-- FOBT Instruction Card (English)
-- FOBT Instruction Card (Spanish)
-- FOBT Training Handbook (English)
-- FOBT Training Handbook (Spanish)
-- Colorectal Display Flipchart (English, Spanish)
-- Letter Mailed To Households (English)
-- Letter Mailed To Households (Spanish)

For costs associated with this program, please contact the developer, Gloria Coronado. (See products page on the RTIPs website for developer contact information.)

A randomized controlled trial evaluated the impact of a clinic-based intervention on colorectal cancer screening among patients of Hispanic ethnicity in South King County, Washington. Patients were recruited from 1 of 11 Sea Mar Community Health Centers in South Park selected because of its convenience. Paper medical records were used to extract baseline screening data on Hispanic patients aged 50–79 years who had a clinic visit at the South Park clinic from January 1, 2002, through May 31, 2006. Patients with a recent colorectal screening exam (a colonoscopy or sigmoidoscopy within the past 5 years or an FOBT within the past 15 months) were excluded from the study.

Patients were randomized to one of two intervention arms or usual care. Patients in the intervention arms received either El Proyecto de Salud Colorectal, consisting of mailing plus outreach (n=168), or just the mailing component of that intervention (n=168). Patients in the usual care group (n=165) did not receive any formal prompting to undergo colorectal cancer screening other than that provided during a physician visit. More than half the participants were aged 50–59 years, and 53% were female, with the age and gender breakdown being approximately the same across the three study groups.  

Promotores reached 115 of the 168 patients in the mailing plus outreach group by phone (16 had invalid addresses and therefore did not receive the mailing, and 37 had disconnected phones or wrong numbers). Of the 37 patients in this group who were eligible for a home visit (i.e., they were still living in the region and had not completed the FOBT), promotores completed 13 home visits. Visits were not made to the remaining patients primarily because promotores had the wrong addresses or patients refused or could not be reached.

The primary outcome was receipt of FOBT. Screening rates were assessed by a review of clinic medical records 9 months after the intervention. In addition, study participants completed a telephone interview assessing screening awareness, participation, knowledge, attitudes, and normative influences.

• At follow-up, compared with screening rates in the usual care group (2%), screening rates were higher in the mailing intervention group (26%; p<.001) and the mailing plus outreach intervention group (31%; p<.001). No significant differences in screening rates were found between the two intervention groups.

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