Summary of Intervention Strategies to Increase Colorectal Cancer Screening and the Supporting Evidence
Level of
Influence
Intervention
Strategy
Individual
Small media
Definition and example
Evidence
review article using strategy]
Video and printed materials such as letters, brochures, and
newsletters
Recommend/Effective
Recommend for FOBT
Insufficient evidence for other
types of screening
Ineffective
Mixed results
One-on-one
education
Deliver information to individuals
One-on-one education can be conducted by telephone or in
person in medical, community, worksite, or household
settings.
Group
education
Educate variety groups of clients
Client incentives
Small, non-coercive rewards (e.g., cash or coupons) that
aim to motivate people to seek cancer screening for
themselves or to encourage others to seek screening
Written (letter, postcard, email) or telephone messages
(including automated messages) advising people that they
are due for screening
Organization Client reminders
Review Article Citation
Number [Number of studies in
Recommend for FOBT
Insufficient evidence for other
types of screening
Effective
Consider; it may facilitate
uptake of CRC screening
Effective
Ineffective
Insufficient evidence
Insufficient evidence
Recommend/effective
Effective for FOBT
Insufficient evidence for other
types of screening
Ineffective
Insufficient evidence
4 [13 studies],
5 [13 studies], 11 [32
studies], 12 [3 studies]
Community guide,
2 [7 studies]
8 [4 studies]
7 [30 studies], 8 [3 studies],
9 [4 studies]
Community guide,
2 [2 studies],
10 [7 studies]
7 [15 studies], 8 [3 studies],
9 [2 studies],
11 [11 studies]
4 [10 studies],
5 [10 studies]
7 [6 studies]
8 [2 studies]
Community guide,
2 [1 study], 4 [2 studies]
5 [2 studies], 10 [2 studies]
Community guide,
10 [1 study]
Community guide, 4 [11
studies], 5 [11 studies],
7 [12 studies], 8 [4 studies]
9 [3 studies] 11 [14 studies]
2 [7 studies],
10 [5 studies]
9 [1 study]
6 [2 studies]
Summary of Intervention Strategies to Increase Colorectal Cancer Screening and the Supporting Evidence
Level of
Influence
Intervention
Strategy
Organization Provider
Assessment and
Feedback
Provider
incentives
Provider
reminder and
recall systems
Community
Mass media
Policy
Reducing
structural
barriers for
clients
Reducing client
out-of-pocket
costs
Definition and example
Evidence
Review Article Citation
Number [Number of studies in
review article using strategy]
To evaluate provider performance in delivering or offering
screening to clients (assessment) and present providers
with information about their performance in providing
screening services (feedback)
Direct or indirect rewards intended to motivate providers
to perform screening or make appropriate referral for their
patients to receive screening
e.g., monetary incentives, continuing medical education
credit
To inform providers it is time for a client’s cancer screening
test or that the client is overdue for screening
e.g., reminders in client charts, e-mail
E.g., television, radio, newspapers, magazines, and
billboards
Reducing time or distance between service delivery settings
and target populations by modifying hours of service;
offering services in alternative or non-clinical settings;
eliminating or simplifying administrative procedures and
other obstacles (e.g., scheduling assistance, patient
navigators, transportation, dependent care, translation
services, limiting the number of clinic visits)
To minimize or remove economic barriers that make it
difficult for clients to access cancer screening services
e.g., vouchers, reimbursements, reduction in co-pays, or
adjustments in federal or state insurance coverage
Recommend
4 [5 studies]
Recommend/effective for FOBT
Community guide,
5 [4 studies], 10 [3 studies]
Insufficient evidence for other
types of screening
Insufficient evidence
Community guide,
10 [1 study]
Community guide,
4 [1 study],
5 [1 study],
10 [3 studies]
Recommend for FOBT and
flexible sigmoidoscopy
Insufficient evidence for other
types of screening
Mixed results
Insufficient evidence
Community guide,
1 [9 studies]
Insufficient evidence
Community guide,
10 [1 study]
Community guide,
3 [7 studies], 5 [1 study],
10 [5 studies]
7 [18 studies], 8 [11
studies], 11 [25 studies]
9 [6 studies]
4 [1 study]
7 [1 study], 11 [1 study]
9 [1 study]
Community guide,
4 [2 studies], 5 [1 study]
Recommend for FOBT
Insufficient evidence for other
types of screening
Effective
Mixed results
Insufficient evidence
Effective
Ineffective
Insufficient evidence
8 [2 studies]
6 [1 study]
Community guide = Guide to Community Preventive Services. Cancer prevention and control. Available at: www.thecommunityguide.org/cancer/index.html
* Denotes systematic reviews that contain citations also found in ACS guides.
Summary of Intervention Strategies to Increase Colorectal Cancer Screening and the Supporting Evidence
Systematic Review Citations
1. Baron, R. C., Melillo, S., Rimer, B. K., et al. (2010). Intervention to increase recommendation and delivery of screening for breast, cervical, and colorectal
cancers by healthcare providers: a systematic review of provider reminders. Am J Pre Med, 38(1), 110-117
2. Baron, R. C., Rimer, B. K., Breslow, R. A., et al. (2008a). Client-directed interventions to increase community demand for breast, cervical, and colorectal
cancer screening: a systematic review. Am J Pre Med, 35(1), S34-S55
3. Baron, R. C., Rimer, B. K., Coates, R. J., et al. (2008b). Client-directed interventions to increase community access to breast, cervical, and colorectal cancer
screening: a systematic review. Am J Pre Med, 35(1), S56-S66
4. Brouwers, M. C., De Vito, C., Bahirathan, L., et al. (2011a). Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening:
an implementation guideline. Implement Sci, 6(1), 112*
5. Brouwers, M. C., De Vito, C., Bahirathan, L., et al. (2011b). What implementation interventions increase cancer screening rates? A systematic
review. Implement Sci, 6(1), 111*
6. Ferroni, E., Camilloni, L., Jimenez, B., et al. (2012). How to increase uptake in oncologic screening: a systematic review of studies comparing populationbased screening programs and spontaneous access. Prev Med, 55(6), 587-596
7. Gimeno Garcia, A. Z., Hernandez Alvarez Buylla, N., Nicolas-Perez, D., & Quintero, E. (2014). Public awareness of colorectal cancer screening: knowledge,
attitudes, and interventions for increasing screening uptake. ISRN Oncol, 2014, p. 425787 *
8. Holden, D. J., Jonas, D. E., Porterfield, D. S., Reuland, D., & Harris, R. (2010). Systematic review: enhancing the use and quality of colorectal cancer
screening. Ann Intern Med, 152(10), 668-676
9. Morrow, J. B., Dallo, F. J., & Julka, M. (2010). Community-based colorectal cancer screening trials with multi-ethnic groups: a systematic review. J Community
Health, 35(6), 592-601
10. Sabatino, S. A., Lawrence, B., Elder, R., et al. (2012). Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine
updated systematic reviews for the guide to community preventive services. Am J Prev Med, 43(1), 97-118
11. Senore, C., Inadomi, J., Segnan, N., Bellisario, C., & Hassan, C. (2015). Optimising colorectal cancer screening acceptance: a review. Gut. 64(7):1158-77*
12. van Agt, H. M., Korfage, I. J., & Essink-Bot, M. L. (2014). Interventions to enhance informed choices among invitees of screening programmes—a systematic
review. Eur J Public Health, 24(5):789-801
This information was assembled by the Cancer Prevention and Control Research Network (CPCRN) FQHC Workgroup Member Sites:
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University of South Carolina
University of North Carolina-Chapel Hill
University of Iowa
Case Western Reserve University
University of Pennsylvania
University of Washington
University of Kentucky
The Cancer Prevention and Control Research Network (CPCRN) is funded jointly by the Centers for Disease Control and Prevention and the National Cancer
Institute.