Cancer Screening: One-on-One Education for Clients — Colorectal Cancer

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends the use of one-on-one education to increase colorectal cancer screening with fecal occult blood testing (FOBT) based on sufficient evidence of effectiveness.

The CPSTF finds insufficient evidence to determine the effectiveness of one-on-one education in increasing colorectal cancer screening tests other than fecal occult blood testing (FOBT), because only two qualifying studies assessed colonoscopy (with inconsistent results), and only one qualifying study assessed flexible sigmoidoscopy (which found no effect).

The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: One-on-One Education for Clients — Colorectal Cancer are available in The Community Guide Collection on CDC Stacks.

Intervention

One-on-one education delivers information to individuals about indications for, benefits of, and ways to overcome barriers to cancer screening with the goal of informing, encouraging, and motivating them to seek recommended screening. These messages are delivered by healthcare workers or other health professionals, lay health advisors, or volunteers, and are conducted by telephone or in person in medical, community, worksite, or household settings.

These messages can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment. One-on-one education is often accompanied by supporting materials delivered via small media (e.g., brochures) and may also involve client reminders.

About The Systematic Review

The CPSTF finding for one-on-one education to increase screening for colorectal cancer by FOBT is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 2 studies, search period 1966-2004) combined with more recent evidence (3 studies, search period 2004-2008). The CPSTF finding for one-on-one education to increase screening for colorectal cancer by colonoscopy or flexible sigmoidoscopy is based on evidence from a Community Guide systematic review published in 2008 (Baron et al., 0 studies, search period 1966-2004) combined with more recent evidence (4 studies, search period 2004-2008).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Study Characteristics

  • Interventions were delivered in home and clinic settings, by phone, in person, or by medical professionals or others.
  • In addition to white participants, studies included African-American, Hispanic, and Asian-American participants; participants with low socioeconomic status; and urban populations.
  • All studies were conducted in the U.S., and none specified inclusion of rural populations.
  • Most studies included participants 50 years and older.

Summary of Results

Combined evidence from the original and updated reviews included 5 studies on one-on-one education to increase cancer screening by FOBT.

  • Screening by fecal occult blood test (FOBT): median increase of 19.1 percentage points (interquartile interval [IQI]: 12.9 to 25.1 percentage points; 10 study arms).
  • Tailored interventions showed increase ranging from 1 to 20.7 percentage points (2 studies)
  • Untailored interventions showed a median increase of 20.7 percentage points (IQI: 13.8 to 25.8 percentage points; 3 studies with 8 study arms)

Combined evidence from the original and updated reviews included 4 studies on one-on-one education to increase cancer screening by colonoscopy or flexible sigmoidoscopy.

  • Screening by colonoscopy: range from 0 to 11 percentage points increase (2 study arms)
  • Screening by flexible sigmoidoscopy: no change reported (1 study arm)
  • Screening by any test (including FOBT): range from 1 to 11 percentage point increase (2 study arms)

Summary of Economic Evidence

The updated search for evidence included nine studies about breast cancer (5 studies), cervical cancer (1 study), or colorectal cancer (3 studies) screening. Monetary values are presented in 2009 U.S dollars.

  • Of the nine included studies, eight reported results from actual interventions and one used economic modeling.
    • The cost per additional screening ranged from $39 to $5,306, with a median of $534.
    • The most expensive intervention was the most resource intensive: Lay health advisors conducted three in-person home visits, made follow-up phone calls, and sent mailings that addressed barriers to screening.

Implementation Considerations and Resources

  • Recruitment and training of educators, quality-control measures, duration of educational sessions, travel for in-person education, and professional backgrounds of educators may influence costs and feasibility of implementation.
  • Interventions may require special skills or tools to develop messages, including tailored messages.

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