Cancer: improving early detection and prevention. A community practice randomised trial

Area of Science:

• Oncology
• Preventive Medicine
• Health Services Research

Background:

• Cancer early detection and preventive services are crucial for reducing cancer morbidity and mortality.
• Ambulatory care practices play a vital role in delivering these essential health services.
• Optimizing service delivery within existing practice structures is key to improving patient outcomes.

Purpose of the Study:

• To evaluate the impact of physician education and office system interventions on cancer early detection and preventive services.
• To compare the effectiveness of education alone versus office system support, and their combination.

Main Methods:

• A randomized trial involving physicians across 98 ambulatory care practices in the United States.
• Interventions included a day-long physician education meeting and facilitator-assisted office system improvements (e.g., staff responsibility division, medical record flow sheets).
• Outcomes measured by patient surveys and medical record reviews assessing the provision of recommended cancer prevention and early detection services.

Main Results:

• The office system intervention significantly increased the uptake of mammography, breast self-examination recommendations, clinical breast examinations, fecal occult blood testing, smoking cessation advice, and dietary fat reduction recommendations.
• Physician education alone was associated with an increase in mammography rates only.
• Record reviews corroborated survey findings for mammography and fecal occult blood testing.

Conclusions:

• Facilitator-assisted development and implementation of office systems can substantially enhance the delivery of cancer early detection and preventive services in community practices.
• System-level changes within practices are more effective than education alone in improving comprehensive cancer prevention delivery.