***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Colorectal cancer ( CRC ) screening is underutilized despite evidence that screening reduces mortality . OBJECTIVE To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening . DESIGN A r and omized clinical trial of community physicians and their patients . PARTICIPANTS Ninety-four community primary care physicians r and omly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group .  Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician , a brochure on CRC screening , and a packet of fecal occult blood test ( FOBT ) cards . MEASUREMENTS After 1 year we measured receipt of the following : ( 1 ) FOBT in the past 2 years , ( 2 ) flexible sigmoidoscopy ( SIG ) or colonoscopy ( COL ) in the previous 5 years , and ( 3 ) any CRC screening . We report the percent change from baseline in both groups . RESULTS 9,652 patients were enrolled for 2 years , and 3,732 patients were enrolled for 5 years . There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years ( 12.7 increase vs 12.5 % , P=.51 ) . Similar results were seen for any CRC screening among patients enrolled for 5 years ( 9.7 % increase vs 8.6 % , P=.45 ) . The only outcome on which the intervention had an effect was on patient rates of screening SIG ( 7.4 % increase vs 4.4 % , P<.01 ) . CONCLUSION With the exception of an increase in rates of SIG in the intervention group , the intervention had no effect on rates of CRC screening . Future interventions should assess innovative approaches to increase rates of CRC screening OBJECTIVE First-degree relatives ( FDRs ) of people diagnosed with colorectal cancer ( CRC ) have a two- to threefold increased risk of developing the same disease . Tailored print interventions based on behavior change theories have demonstrated considerable promise in facilitating health-promoting behaviors . This study compared the impact of two mailed print interventions on CRC screening outcomes among FDRs . METHODS This r and omized trial compared effects of two mailed print interventions --one tailored and one nontailored -- on participation in CRC screening among FDRs of CRC survivors . Data collected via phone interviews from 140 FDRs at baseline , 1 week post-intervention , and 3 months post-intervention . RESULTS At 3 months , both the tailored and nontailored interventions yielded modest but statistically insignificant increases in adherence to any CRC screening test ( 14 % vs. 21 % , respectively ; p=0.30 ) . While there were no main effects for tailored versus nontailored interventions , there were significant interactions that showed that the tailored print intervention had significantly greater effects on forward stage movement for CRC screening depending on stage of adoption at baseline , race , and objective CRC risk . Receipt of the tailored intervention was 2.5 times more likely to move baseline precontemplators and contemplators forward in stage of adoption for colonoscopy ( 95 % CI : 1.10 - 5.68 ) and was three times more likely to move Caucasians forward in stage of adoption for FOBT ( 95 % CI : 1.00 - 9.07 ) . In addition , the tailored intervention was 7.7 times more likely to move people at average risk forward in stage of adoption for colonoscopy ( 95 % CI : 1.25 - 47.75 ) . CONCLUSION The tailored print intervention was more effective at moving Caucasians , those in precontemplation and contemplation at baseline , and those at average risk forward in their stage of adoption for CRC screening . PRACTICE IMPLICATION S Both tailored and nontailored print interventions showed moderate effects for increasing CRC screening participation .  Tailored print interventions may be more effective for certain subgroups Background : Interventions to improve adherence to regular mammography screening  have had conflicting results . Many studies have depended on women ’s self-report rather than clinical evidence of a mammography encounter . Methods : We tested the impact of two interventions on a population -based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved . The interventions included a mailing of women ’s health information and a telephone counseling intervention based on the Transtheoretical Model . Participant eligibility and outcome measures were based on clinical events obtained from a population -based mammography registry . Results : Two hundred and fifty eight women completed all aspects of the intervention study . The women were r and omly assigned to one of two study groups : 51 % received the mail intervention and 49 % received the telephone intervention . Among women who received the telephone counseling intervention , 67 % percent reported being in either an action or maintenance stage at Call 1 , which increased to 84 % at Call 2 ( p<0.001 ) . Seventy-six percent of women identified barriers to screening mammography at Call 1 , which decreased to 44 % at Call 2 ( p<0.01 ) . The most frequently identified barrier was confusion over the guidelines for screening mammography . At the first assessment time interval , greater than 60 % of women were up-to- date for screening mammography in the group that received telephone counseling versus 48 % in the group that received health information by mail ( p = 0.04 ) . However , women ’s status as up-to- date fell for both groups between the first and second assessment time intervals . Conclusions : Tailored telephone counseling based on the Transtheoretical Model can improve adherence to screening mammography , though the duration of this effect is in question Abstract BACKGROUND : R and omized controlled trials have demonstrated that fecal occult blood testing ( FOBT ) reduces colorectal cancer ( CRC ) mortality . However , patient compliance with FOBT is low and this is one of the major barriers to CRC screening . OBJECTIVE : To determine whether intensive patient education increases FOBT card return rates . DESIGN : R and omized controlled trial . SETTING : Department of Veterans Affairs primary care clinic . PARTICIPANTS : Seven hundred eighty-eight patients who were referred for FOBT . INTERVENTIONS : Patients were r and omly allocated to receive either intensive ( n=396 ) or st and ard ( n=392 ) patient education . Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening , were instructed on how to properly collect stool specimens for FOBT , and were given a 2-page h and out on CRC screening . Patients in the st and ard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT . RESULTS : Patients in the intensive education group were more likely to return the FOBT cards ( 65.9 % vs 51.3 % ; P<.001 ) and called the clinic with additional questions less often ( 1.5 % vs 5.9 % ; P=.001 ) than the st and ard education group . The median time to return the FOBT cards was significantly shorter in the intensive education group ( 36 vs 143 days ; P<.001 by log-rank test ) . However , the proportion of patients who had a positive FOBT did not differ in the two groups ( 4.6 % vs 6.0 % ; P=.51 ) . CONCLUSIONS : Intensive patient education significantly improved patient compliance with FOBT . Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted Background Individuals with a sibling who has had colorectal cancer diagnosed before age 61 are at increased risk for colorectal cancer and may derive particular benefit from screening . Tailored interventions may increase participation in appropriate colorectal cancer screening . Purpose This study evaluated the efficacy of two tailored interventions and a generic print intervention . Methods Participant siblings ( N = 412 ) who were not up-to- date with colorectal cancer screening were r and omly assigned to receive either a generic print pamphlet , a tailored print pamphlet , or a tailored print pamphlet and tailored counseling call .  Colorectal cancer screening 6 months after the baseline interview was the outcome measure . Results Results indicated that colorectal cancer screening adherence increased among intermediate risk siblings enrolled in all three intervention groups . Participants in both tailored intervention groups reported having colorectal cancer screening at significantly higher rates than participants in the generic print group . The increase in colorectal cancer screening in the tailored print and counseling call group was not significantly higher than that achieved by the tailored print alone . Decisional balance partially mediated treatment effects . Tailored behavioral interventions are effective methods for increasing screening adherence but telephone counseling did not add significantly to treatment effects Background : Low-income African American women face numerous barriers to mammography screening . We tested the efficacy of a combined interactive computer program and lay health advisor intervention to increase mammography screening . Methods : In this r and omized , single blind study , participants were 181 African American female health center patients of ages 41 to 75 years , at ≤250 % of poverty level , with no breast cancer history , and with no screening mammogram in the past 15 months . They were assigned to either ( a ) a low-dose comparison group consisting of a culturally appropriate mammography screening pamphlet or ( b ) interactive , tailored computer instruction at baseline and four monthly lay health advisor counseling sessions . Self-reported screening data were collected at baseline and 6 months and verified by medical record . Results : For intent-to-treat analysis of primary outcome ( medical record – verified mammography screening , available on all but two participants ) , the intervention group had increased screening to 51 % ( 45 of 89 ) compared with 18 % ( 16 of 90 ) for the comparison group at 6 months . When adjusted for employment status , disability , first-degree relatives with breast cancer , health insurance , and previous breast biopsies , the intervention group was three times more likely ( adjusted relative risk , 2.7 ; 95 % confidence interval , 1.8 - 3.7 ; P < 0.0001 ) to get screened than the low-dose comparison group . Similar results were found for self-reported mammography stage of screening adoption . Conclusions : The combined intervention was efficacious in improving mammography screening  in low-income African American women , with an unadjusted effect size ( relative risk , 2.84 ) significantly higher ( P < 0.05 ) than that in previous studies of each intervention alone . Cancer Epidemiol Biomarkers Prev ; 19(1 ) ; Background . The American Cancer Society ( ACS ) is interested in facilitating colorectal cancer screening ( CRCS ) in primary care . Methods . Similar clinics were assigned r and omly to 1 of 3 CRCS arms : ( 1 ) usual care , ( 2 ) exam-room posters design ed by the ACS ; and ( 3 ) posters plus patient reminder calls from an ACS volunteer . Results . Compared to patients due for screening in Arm 1 , the odds ratio for getting CRCS in Arm 2 was 1.04 ( 95 % confidence interval [ CI ] , 0.81–1.34 ) , P value not significant ; in Arm 3 , it was 1.49 ( 95 % CI , 1.16–1.90 ) , P value < .001 . Conclusions . Exam-room posters plus patient reminder calls from the ACS can increase CRCS in primary care Background : Publicly-funded health centers serve disadvantaged population s who underuse colorectal cancer screening ( CRC ) . Because physicians play a key role in patient adherence to screening , provider interventions within health center practice s could improve the delivery/utilization of CRC screening . Methods : A 2-group study design was used with 4 pairs of health centers r and omized to the intervention or control condition . The provider intervention featured academic detailing of the small practice groups , followed by a strategic planning session with the entire health center staff using SWOT analysis . The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and /or completion of CRC screening  was determined by medical record audit ( n = 2224 ) . The intervention effect was evaluated using generalized estimating equations . Pre-post intervention patient surveys ( n = 281 ) were conducted . Results : Chart audits of the 1 year period before and after the intervention revealed a 16 % increase from baseline in CRC screening referral/dispensing/completion among intervention centers , compared with a 4 % increase among controls , odds ratio ( OR ) = 2.25 ( 1.67–3.04 ) P < 0.001 . Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up ( P = 0.04 ) . Conclusions : Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise BACKGROUND Few health promotion trials have evaluated strategies to increase regular mammography screening . We conducted a r and omized controlled trial of two theory-based interventions in a population -based , nationally representative sample of women veterans . METHODS Study c and i date s 52 years and older were r and omly sample d from the National Registry of Women Veterans and r and omly assigned to three groups . Groups 1 and 2 received interventions that varied in the extent of personalization ( tailored and targeted vs targeted- 
    Output:
    
Client reminders , small media , and provider audit and feedback  appear to be effective interventions to increase the uptake of screening for three cancers .
One-on-one education and reduction of structural barriers also appears effective , but their roles with CRC and cervical screening , respectively , are less established .
Conclusion The new evidence generally aligns with the evidence and conclusions from the original systematic review s. This review served as the evidentiary foundation for an implementation guideline .