Phone counseling another avenue to encourage colonoscopy

Referring patients to a telephone counseling intervention that promotes colorectal cancer (CRC) screening is a feasible strategy for primary care physicians to use and may coax some hesitant patients to follow through with screening, according to a study published Sept. 16 in the American Journal of Managed Care.

While only half of the patients accepted the referral when offered, and only about one-third of those who accepted were successfully reached for counseling, many of those who did eventually complete the counseling call acknowledged that it convinced them to receive CRC screening.

Study authors Roger Luckmann, MD, MPH, of the University of Massachusetts Medical School, Worcester, and colleagues tested the phone counseling intervention with primary care physicians at three practices. The physicians were prompted to recommend telephone counseling about CRC screening when appropriate, and if accepted by the patient, a counselor would call to make an appointment for counseling. Patients would also receive an educational booklet they could review prior to counseling. After seven months, the authors searched patients’ electronic records for evidence of colonoscopy.

Of the 1,945 patients who discussed CRC screening with their primary care physician, 362 were referred for phone counseling. Of these, 49.7 percent accepted the referral and 37.2 percent of referred patients successfully received counseling.

While 54.6 percent of patients were planning on CRC screening at the beginning of the call, 93.9 percent indicated they would seek screening following the phone counseling session. Records indicated that 53.2 percent of patients planning on a colonoscopy actually received one within seven months.

“Since most patients who changed stage did so after the educational module, educational intervention alone may be as effective as education plus motivational interviewing,” wrote Luckmann and colleagues.

The authors speculated that if primary care physicians were given training on how to motivate patients to accept the referral, then it might increase acceptance of counseling. Even without this modification, Luckmann and colleagues wrote that “the study demonstrates that this type of intervention is at least feasible in primary care practice given the willingness of all [primary care physicians] and some patients to engage in the intervention as designed.”