***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: Purpose . To conduct a pilot test of a decision aid design ed to help patients choose among currently recommended colorectal cancer screening programs . Methods . R and omized controlled trial comparing a patient decision aid based on multi criteria decision-making theory with a simple educational intervention . Patient population . 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester , New York . Outcome measures . The two primary outcome measures were patient decision process and the decision outcome . Patient decision process was assessed using the decisional conflict scale . Decision outcome was defined as the proportion of colorectal cancer screening plans carried out . Results . After controlling for the effects of the physicians in a factorial analysis of variance , patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions ( F ratio6.47 , P = 0.01 ) due to increased knowledge , better clarity of values , and higher ratings of the quality of the decisions they made . There was no difference between the groups in decision outcomes : 52 % of patients in the control group and 49 % in the experimental group completed planned screening tests ( P = 1.0 ) . Conclusions . In a pilot study , a multi criteria -based patient decision aid for colorectal cancer screening improved patients ’ decision-making processes but had no effect on the implementation of screening plans 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 We tested an intervention based on social learning theory ( SLT ) to improve colorectal  cancer ( CRC ) screening among Native Hawaiians , a group with low CRC screening rates . METHOD Sixteen Hawaiian civic clubs agreed to r and omization . Eight control clubs received a culturally targeted presentation , a free Fecal Occult Blood Test ( FOBT ) , and a reminder call . Eight experimental clubs also received culturally targeted education and free testing ; but , in line with SLT , education was delivered by a Native Hawaiian physician and Native Hawaiian CRC survivor , and members received an FOBT demo , were challenged to involve a family member in screening , and were telephoned multiple times to address change-related emotions and barriers . RESULTS One hundred twenty-one members age 50 and older from 16 clubs participated . At the club level , screening rates were modestly increased in four experimental clubs and six control clubs . Surprisingly , 64 % of participants reported being up to date with CRC screening at baseline . Only 13 individuals ( five in experimental arm and eight in the control arm ) were screened for the first time through this intervention , increasing the percent screened from 59 % to 67 % in the experimental group and from 69 % to 85 % in the control group . Although individuals in the experimental arm were more likely to rate the intervention as culturally appropriate , both arms realized similar and significant gains in CRC knowledge , attitudes , intent , and self-efficacy . CONCLUSIONS For Native Hawaiian individuals belonging to a network of civic clubs , an intervention based on SLT delivered by a Native Hawaiian physician and CRC survivor was less effective at further increasing compliance than was a culturally targeted educational session delivered by a non-Hawaiian nurse . That CRC screening compliance was high prior to our intervention suggests that we targeted a very health conscious segment of the Native Hawaiian population . Future work should focus on underserved segments of this indigenous group OBJECTIVES : Socioeconomic status is explored as a predictor of differences between Hispanics and non-Hispanic Whites in cancer prevention behavior . METHODS : In a cross-sectional study ,  in-person interviews ( n = 1795 ) were conducted in a population -based r and om sample of adults in 20 communities with a high proportion of Hispanics . RESULTS : Hispanics were significantly less likely than non-Hispanic Whites to ever have had cervical ( p < 0.001 ) , breast ( p = 0.007 ) , or colorectal cancer ( FOBT p = 0.008 ; sigmoidoscopy/colonoscopy p < 0.002 ) screening . After adjusting for socioeconomic status ( education and having health insurance ) , only differences in cervical cancer remained significant ( p = 0.024 ) . After adjusting for socioeconomic status , Hispanics had a significantly higher intake of fruits and vegetables per day ( 4.84 servings ) than non-Hispanic Whites ( 3.84 servings ) ( p < 0.001 ) ; and fat behavior score was marginally significant after adjustment for socioeconomic status ( p = 0.053 ) . Significantly fewer Hispanics were current smokers than non-Hispanic Whites ( p < 0.001 ) . CONCLUSIONS : There is only limited support for the hypothesis that socioeconomic status is a major determinant of some cancer-related behaviors ; specifically , socioeconomic status is related to mammography and colorectal screening , but not cervical cancer , dietary behavior , or smoking Colorectal carcinoma ranks as the second most common cancer and the second leading cause of cancer death in the United States . Hispanics are less likely than their non‐Hispanic white counterparts to have ever received a  fecal occult blood test ( FOBT ) or sigmoidoscopy/colonoscopy . Little is known about the barriers to screening in the Hispanic population BACKGROUND Screening reduces colorectal cancer mortality , but effective screening tests remain underused . Systematic reminders to patients and physicians could increase screening rates METHODS We conducted a r and omized controlled trial of patient and physician reminders in 11 ambulatory health care centers . Participants included 21 860 patients aged 50 to 80 years who were overdue for colorectal cancer screening and 110 primary care physicians . Patients were r and omly assigned to receive mailings containing an educational pamphlet , fecal occult blood test kit , and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy . Physicians were r and omly assigned to receive electronic reminders during office visits with patients overdue for screening . The primary outcome was receipt of fecal occult blood testing , flexible sigmoidoscopy , or colonoscopy over 15 months , and the secondary outcome was detection of colorectal adenomas . RESULTS Screening rates were higher for patients who received mailings compared with those who did not ( 44.0 % vs 38.1 % ; P < .001 ) . The effect increased with age : + 3.7 % for ages 50 to 59 years ; + 7.3 % for ages 60 to 69 years ; and + 10.1 % for ages 70 to 80 years ( P = .01 for trend ) . Screening rates were similar among patients of physicians receiving electronic reminders and the control group ( 41.9 % vs 40.2 % ; P = .47 ) . However , electronic reminders tended to increase screening rates among patients with 3 or more primary care visits ( 59.5 % vs 52.7 % ; P = .07 ) . Detection of adenomas tended to increase with patient mailings ( 5.7 % vs 5.2 % ; P = .10 ) and physician reminders ( 6.0 % vs 4.9 % ; P = .09 ) . CONCLUSIONS Mailed reminders to patients are an effective tool to promote colorectal cancer screening , and electronic reminders to physicians may increase screening among adults who have more frequent primary care visits BACKGROUND Although colorectal cancer screening by using a fecal occult blood test ( FOBT ) , flexible sigmoidoscopy , colonoscopy , or barium enema x-ray reduces the incidence of and death from colorectal cancer , the rate of colorectal cancer screening in the general population is low . We conducted a r and omized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County , Minnesota , a community in which colorectal cancer screening was promoted . METHODS At baseline , we mailed a question naire about colorectal cancer screening to a r and om sample of Wright County residents aged 50 years or older who were r and omly selected from the Minnesota State Driver 's License and Identification Card data base ( estimated N = 1451 ) . The sample was r and omly allocated into three equal subgroups : one group ( control ) received only the question naire , one group received FOBT kits by direct mail with reminders , and one group received FOBT kits by direct mail without reminders . Study participants were sent a follow-up question naire 1 year after baseline . We used the responses to the question naires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups , along with the associated bootstrap 95 % confidence intervals ( CIs ) . RESULTS At baseline , the estimated response rate was 86.5 % , self-reported adherence to FOBT guidelines was 21.5 % , and overall adherence to any colorectal cancer screening test guidelines was 55.8 % . The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5 % ( 95 % CI = -2.9 % to 5.9 % ) for the control group , 16.9 % ( 95 % CI = 11.5 % to 22.3 % ) for the direct-mail-FOBT-with-no-reminders group , and 23.2 % ( 95 % CI = 17.2 % to 29.3 % ) for the direct-mail-FOBT-with-reminders group . The 1-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8 % ( 95 % CI = 3.2 % to 12.0 % ) for the control group , 13.2 % ( 95 % CI = 8.4 % to 18.2 % ) for the direct-mail-FOBT-with-no-reminders group , and 14.1 % ( 95 % CI = 9.1 % to 19.1 % ) for the direct-mail-FOBT-with-reminders group . CONCLUSION Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign As of 2004 , almost 45 % of adults age 50 years or older were not up-to- date with colorectal cancer ( CRC ) screening ( 1 ) . In community setting s , a key barrier to screening is the absence of a primary care physician recommending screening ( 2 ) . Nonetheless , previous work has demonstrated that adherence is low even when patients have face-to-face discussion s with and receive referrals for screening from their primary care physicians ( 3 ) . This observation is particularly true for colonoscopy , a high-intensity procedure that requires considerable advance preparation . We have reported in our clinical system the reasons for not adhering to colonoscopy referrals , including the belief that one is not at risk for CRC because of an absence of symptoms or a family history of disease , fear of pain associated with the procedure , perceived unpleasantness of the bowel preparation , forgetfulness , and uncertainty about who is responsible for scheduling the procedure ( 3 ) . Nonadherence to referrals for coloscopy represents a missed opportunity to realize public health goals and achieve quality of care for individual patients and also entails unnecessary administrative time and expense to complete , transmit , and archive referral forms and obtain insurance preauthorization . Although mailed prompts and informational material have been shown to be effective in promoting other types of cancer screening tests ( 49 ) , we are unaware of previous studies that have tested this strategy for patients who receive referrals for screening colonoscopy . In an effort to reduce nonadherence to screening colonoscopy , we developed a 1-page , 2-sided brochure to be mailed to patients shortly after receiving referrals for the procedure . The brochure was 
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RESULTS We found multiple problems of underuse , overuse , and misuse of CRC screening .
Being insured , of higher income or education , and non-Hispanic white , participating in other cancer screenings , having a family history of CRC or personal history of another cancer , as well as receiving a physician recommendation to be screened , are associated with higher screening rates .
Interventions that effectively increased CRC screening with high strength of evidence include patient reminders , one-on-one interactions , eliminating structural barriers , and system-level changes .
The largest magnitude of improvement came from one-on-one interactions and eliminating barriers .
Purely educational small-media interventions do not improve screening rates .
Evidence is mixed for decision aids , although certain design s may be effective .
Both CRC screening and patient-physician discussion s of CRC screening are underused , and important problems of overuse and misuse also exist .
Some interventions hold promise for improvement .