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Am Fam Physician. 2000;61(12):3682-3683

Flexible sigmoidoscopy every five years is recommended for colorectal cancer screening in patients more than 50 years of age with average risk factors for the disease. This method of screening is underused, however, particularly in low-income populations. Zubarik and colleagues studied the impact of an educational program aimed at physicians, nurses and patients on utilization of flexible sigmoidoscopy for colorectal cancer screening.

The educational program to encourage flexible sigmoidoscopy for colorectal cancer screening was conducted at a metropolitan hospital and its satellite clinics. Physicians were encouraged to refer appropriate patients for flexible sigmoidoscopy. Screening was emphasized formally in monthly lectures and informally in weekly morning reports. Gastroenterology nurses educated clinic nurses regarding the importance of flexible sigmoidoscopy for colorectal cancer screening. Nurses then contacted patients who were due to have flexible sigmoidoscopy screening and stressed the importance of undergoing the procedure.

To assess the impact of the educational initiative, the authors compared utilization of flexible sigmoidoscopy screening five months before and five months after the educational initiative. Only patients who were at least 50 years old and had an average risk for colorectal cancer were included in the study. The study population came from a low-income area.

There was a significant increase in the number of patients who underwent flexible sigmoidoscopy for colorectal cancer screening after the educational intervention. In the five-month period before implementation of the educational program, 50 patients underwent screening sigmoidoscopy. In contrast, after the educational initiative, 71 patients underwent such screening during a five-month period. This difference represented a 42 percent increase in the number of patients screened for colorectal cancer. No decline in the number of patients undergoing this screening procedure was noted toward the end of the study, indicating that the education initiative resulted in a sustained change in behaviors.

The authors conclude that the educational intervention improved the utilization of flexible sigmoidoscopy for colorectal cancer screening. This improvement occurred in a group of patients who traditionally do not participate in preventive services.

editor's note: Even though physicians believe prevention is important, many studies have shown that most of us fall short in providing all of the recommended preventive services. Multiple factors play a role, including those related to physicians, the office structure and patients. In this study, Zubarik and associates documented that an educational intervention aimed at physicians, office staff and patients improved compliance with colorectal cancer screening. Such an approach could be replicated in physicians' offices to increase the number of patients who receive the appropriate preventive services.—k.e.m.

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