Open Access Open Badges Research article

Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: results from a pragmatic cluster randomized controlled trial

Kathleen Clouston1*, Alan Katz2, Patricia J Martens3, Jeff Sisler4, Donna Turner5, Michelle Lobchuk6, Susan McClement7, Gary Crow8 and the CIHR/CCMB Team in Primary Care Oncology (PCO-NET)9

Author Affiliations

1 Department of Family Medicine Research, Faculty of Medicine, University of Manitoba, 208 Baisinger Drive, Winnipeg R2N 4H7 MB, Canada

2 Departments of Family Medicine and Community Health Sciences, Faculty of Medicine, University of Manitoba, P228-770 Bannatyne Ave, Winnipeg, MB R3E 0 W3, Canada

3 Department of Community Health Sciences, Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada

4 Primary Care Oncology Program, CancerCare Manitoba, 675 McDermot Ave, Room ON2038, Winnipeg R3E 0 V9, MB, Canada

5 Provincial Director of Population Oncology, CancerCare Manitoba, 675 McDermot Ave, 4th Floor Executive Offices, Winnipeg R3E 0 V9, MB, Canada

6 Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Room 315-89 Curry Place, Winnipeg, MB R3T 2 N2, Canada

7 Faculty of Nursing, University of Manitoba; CancerCare Manitoba, Office # 3017, 675 Mc Dermot Avenue, Winnipeg R3E 0 V9, MB, Canada

8 Faculty of Agriculture, Department of Animal Science, University of Manitoba, 230 Animal Science Building, Winnipeg, MB R3T 2 N2, Canada

9 CIHR/CCMB Primary Care Oncology Research Team, 385 Main Street, Winkler, MB R6W 1J2, Canada

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BMC Cancer 2014, 14:263  doi:10.1186/1471-2407-14-263

Published: 16 April 2014



Evaluation of the effectiveness of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website), distributed to patients by their family physician, in improving fecal occult blood test (FOBT) colorectal cancer screening rates.


A pragmatic, two arm, cluster randomized controlled trial in Winnipeg, Manitoba, Canada (39 medical clinic clusters; 79 fee-for-service family physicians; 2,395 average risk patients). All physicians followed their standard clinical screening practice. Intervention group physicians provided a fridge magnet to patients that facilitated patient decision aid access. Primary endpoint was FOBT screening rate within four months.

Multi-level logistic regression to determine effect of cluster, physician, and patient level factors on patient FOBT completion rate. ICC determined.


Family physicians were randomized to control (n = 39) and intervention (n = 40) groups. Compared to controls (56.9%; n = 663/1165), patients receiving the intervention had a higher FOBT completion rate (66.6%; n = 805/1209; OR of 1.47; 95% confidence interval 1.06 to 2.03; p < 0.02). Patient aid utilization was low (1.1%; 13/1,221) and neither internet nor telephone access affected screening rates for the intervention group. FOBT screening rates differed among clinics and physicians (p < 0.0001). Patients whose physician promoted the FOBT were more likely to complete it (65%; n = 1140/1755) compared to those whose physician did not (51.1%; n = 242/470; p < 0.0001; OR of 1.54 and 95% CI of 1.23 to 1.92). Patients reporting they had done an FOBT in the past were more likely to complete the test (70.6%; n = 1141/1616; p < 0.0001; 95% CI 2.51 to 3.73) than those who had not (43%; n = 303/705). Patients 50–59 years old had lower screening rates compared to those over 60 (p < 0.0001). 75% of patients completing the test did so in 34 days.


Despite minimal use of the patient aid, intervention group patients were more likely to complete the FOBT. Powerful strategies to increase colorectal cancer screening rates include a recommendation to do the test from the family physician and focusing efforts on patients age 50–59 years to ensure they complete their first FOBT.

Trial registration

Trial registration number: identifier NCT01026753.

Colorectal cancer screening; Fecal occult blood test; Community-based family practice; Community-based primary healthcare research; Cluster randomized controlled trial; Pragmatic; Patient decision aid; Integrated knowledge translation; Knowledge exchange