Cancer Screening: Small Media Targeting Clients — Colorectal Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends interventions that use small media based on strong evidence of their effectiveness in increasing colorectal cancer screening by fecal occult blood test (FOBT). The CPSTF finds insufficient evidence to determine the effectiveness of using small media to increase colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema because no studies evaluating these screening procedures were identified.
The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Small Media Targeting Clients — Colorectal Cancer are available in The Community Guide Collection on CDC Stacks.
Intervention
Small media include videos and printed materials such as letters, brochures, and newsletters. These materials can be used to inform and motivate people to be screened for cancer. They can provide information tailored to specific individuals or targeted to general audiences.
About The Systematic Review
The CPSTF finding for small media to increase colorectal cancer screening by FOBT is based on evidence from a systematic review of 7 studies (search period 1966–2004). No studies were included for interventions to increase colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema. The 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
- Evaluated interventions used a personal record booklet; leaflets or pamphlets; videos, newsletters, or other printed materials; or a sequence of two letters
- Studies were conducted in urban and rural populations and included study participants from both clinical and community settings
- Of the 7 included studies, only one evaluated a tailored intervention
Summary of Results
Seven studies on interventions to increase colorectal cancer screening by FOBT were included in the systematic review.
- Proportion of study participants completing screening by FOBT: median increase of 12.7 percentage points (Interquartile interval: 0 to 26.4 percentage points; 8 study arms)
No studies were included for interventions to increase colorectal cancer screening by flexible sigmoidoscopy, colonoscopy, or double contrast barium enema.
Summary of Economic Evidence
Two studies qualified for the review of interventions to increase colorectal cancer screening by FOBT. Monetary values are presented in 2009 U.S dollars.
- One study reported the average intervention cost was $150 per person screened
- One study found the cost per additional person screened was $44.49
Applicability
Findings should apply to a range of populations and settings, provided the intervention is appropriately adapted to the target population and delivery context.
Evidence Gaps
- Does effectiveness of small media differ by choice of medium (e.g., letter, video, brochure, or Internet-delivered application), information source (e.g., personal physician, educator), or intensity or frequency of delivery?
- What is the relative cost effectiveness of tailored versus untailored messages?
- How does the effectiveness of interventions to increase community demand for screening vary with the health literacy of a target population or subpopulation?
- How can newer methods of communication including automated telephone calls and Internet-delivered applications be used to improve delivery, acceptance, and effectiveness of these interventions?
- How effective are these interventions in increasing screening by colorectal endoscopy or by double contrast barium enema (for which no qualifying studies were identified)?
- What is required to disseminate and implement effective interventions in community settings across the United States?
- How can or should these approaches be applied to assure that screening, once initiated, is maintained at recommended intervals?
- With respect to interventions that may be tailored to individuals, how are effective tailoring programs adapted, disseminated, and implemented in community-based settings across the United States?
Implementation Considerations and Resources
- Primary barriers to implementing a small media intervention include limited resources and infrastructure
- Access to effective marketing strategies, educational messages, and instructional materials (particularly for specific subgroups) may be limited by cost and special skills required to develop and test these messages
- Materials libraries (such as those available at National Cancer Institute’s Evidence-Based Cancer Control Programs) are a potential source of high quality, topic- and population-specific messages developed as components of evidence-based programs
- Production and dissemination of tailored messages may be more costly and resource intensive than untailored programs because tailoring generally requires new data collection, development of extensive message libraries with graphics, and computer programming support to ensure appropriate individualization
- Cost effectiveness may improve through economies of scale
- Web-based tailored intervention programs may provide a good solution to both the cost and complexity of developing and delivering tailored interventions to promote cancer screening
- Recruitment, training, and support of community health workers and other interventionists to deliver educational messages may pose substantial barriers in smaller community or free-standing clinical settings
- Regional or other aggregations of populations and services might be considered as strategies to overcome this problem
Crosswalks
Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.