Colorectal Cancer

The following paper was published in the April 2008, Cancer Epidemiol Bimarkers & Prevention

Reliability and Validity of a Questionnaire to Measure Colorectal Cancer Screening Behaviors: Does Mode of Survey Administration Matter?

Vernon SW¹, Tiro JA¹, Vojvodic RW¹, Coan S¹, Diamond PM¹, Greisinger A³, Fernandez ME².

¹ University of Texas-Houston School of Public Health, Division of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, Houston, Texas;

²Cancer Prevention Fellowship Program, Office of Preventive Oncology, National Cancer Institute, Bethesda, Maryland; and

³Kelsey Research Foundation, Houston, Texas.

OBJECTIVE: Valid and reliable self-report measures of cancer screening behaviors are important for evaluating efforts to improve adherence to guidelines.

METHODS: We evaluated test-retest reliability and validity of self-report of the fecal occult blood test (FOBT), sigmoidoscopy (SIG), colonoscopy (COL), and barium enema (BE) using the National Cancer Institute colorectal cancer screening (CRCS) questionnaire. A secondary objective was to evaluate reliability and validity by mail, telephone, and face-to-face survey administration modes. Consenting men and women, 51 to 74 years old, receiving care at a multispecialty clinic for at least 5 years who had not been diagnosed with colorectal cancer were stratified by prior CRCS status and randomized to survey mode (n = 857). Within survey mode, respondents were randomized to complete a second survey at 2 weeks, 3 months, or 6 months.

RESULTS: Comparing self-report with administrative and medical records, concordance estimates were 0.91 for COL, 0.85 for FOBT, 0.85 for SIG, and 0.92 for BE. Overall sensitivity estimates were 0.91 for COL, 0.82 for FOBT, 0.76 for SIG, and 0.56 for BE. Specificity estimates were 0.91 for COL, 0.86 for FOBT, 0.89 for SIG, and 0.97 for BE. Sensitivity and specificity varied little by survey mode for any test. Report-to-records ratio showed overreporting for SIG (1.1), COL (1.15), and FOBT (1.57), and underreporting for BE (0.82). Reliability at all time intervals was highest for COL; there was no consistent pattern according to survey mode.

CONCLUSIONS: This study provides evidence to support the use of the National Cancer Institute CRCS questionnaire to assess self-report with any of the three survey modes.

 

Colorectal Cancer

The following paper was published in the June 23, 2006, Journal of the American Informatics Association.

Estimating Development Cost for a Tailored Interactive Computer Program to Enhance Colorectal Cancer Screening Compliance

David R. Lairson, PhD¹, Yu-Chia Change, MPH¹, Judith L. Bettencourt, MPH¹, Sally W. Vernon, PhD¹, Anthony Greisinger, PhD²

¹School of Public Health, University of Texas Health Science Center at Houston,

²Kelsey Research Foundation
 

Abstract

We use an actual-work estimate method to estimate the cost of developing a tailored interactive computer education program to improve compliance with colorectal cancer screening guidelines in a large multi-specialty group medical practice. Resource use was prospectively collected from time logs, administrative records, and a design and computing subcontract. Sensitivity analysis was performed to examine the uncertainty of the overhead cost rate and other parameters. The cost of developing the system was $328,866. The development cost was $52.79 per patient when amortized over a seven-year period with a cohort of 1,000 persons. About 20% of the cost was incurred in defining the theoretic framework and supporting literature, constructing the variables and survey and conducting focus groups. About 41% of the cost was for developing the messages, algorithms and constructing program elements, and the remaining cost was to create and test the computer education program. About 69% of the cost was attributable to personnel expenses. Development cost is rarely estimated but is important for feasibility studies and ex-ante economic evaluation of alternative interventions. The findings from this study may aid decision-makers in planning, assessing, budgeting and pricing development of tailored interactive computer-based interventions.

Acknowledgement: This project was supported by the National Cancer Institute, grant no. 501 ROI CA097263.

 

Colorectal Cancer

The following article was published in Cancer Detect Prev., 2006; 30 (1): 67-74

Primary care patients' understanding of colorectal cancer screening

Anthony Greisinger PhD^{1, ,} , Sarah T. Hawley PhD², Judy L. Bettencourt MPH³, Catherine A. Perz PhD⁴ and Sally W. Vernon PhD<sup>3

1</sup>Kelsey Research Foundation, 5615 Kirby, Suite 660, Houston, TX 77054, USA

²University of Michigan, Ann Arbor, MI 48109, USA

³Houston School of Public Health, University of Texas, Houston, TX 77030, USA

⁴University of Houston Victoria, Victoria, TX 77901, USA

Purpose: To determine the current level of awareness and understanding about colorectal cancer (CRC) and colorectal cancer screening (CRCS) among primary care patients in order to develop interventions to educate patients about options for CRCS, help them identify CRCS preferences and make informed choices about CRCS options.

Methods: During the spring of 2001 and 2003, two sets of focus groups with primary care patients were conducted at a large multi-specialty group practice in Houston, Texas.

Results: Participants (n = 42) in both sets of focus groups had low knowledge about CRC and expressed fear and embarrassment about CRC and CRCS. Attitudes towards the fecal occult blood test (FOBT) were mixed, with some participants considering it difficult to finish and others preferring the privacy it afforded. Some participants initially failed to recognize the difference between sigmoidoscopy (SIG) and colonoscopy (COL), and several endoscopy-specific barriers were identified such as fear of pain, embarrassment/humiliation, and dislike or fear of test preparation. Some participants felt that endoscopy was likely to be more effective than FOBT, and others clearly preferred COL to SIG. System-specific barriers to endoscopy (e.g. difficulty scheduling appointments and insurance coverage) were also identified. We found little change in the barriers reported by primary care patients, despite a two-year difference between focus groups. Participants also provided suggestions for improving CRCS including telephone, letters and/or email reminders from the clinic, videotapes and websites.

Conclusions: Future interventions focused on improving informed decision-making by educating primary care patients about the risks and benefits of specific test options and about the importance of early detection of CRC could prove to be effective for increasing CRCS.