Three strategies to promote cancer screening. How feasible is wide-scale implementation?

Many studies have tested the efficacy of intervention strategies for improving physicians' performance of cancer screening tests. Less attention has been paid to the feasibility of strategy implementation. Three important dimensions of feasibility are acceptability to the targeted audience, logistical difficulties, and cost and cost-effectiveness. We assessed the relative feasibility along these dimensions of three intervention strategies shown previously to be efficacious among 62 internal medicine resident physicians. Two strategies, medical record audit with feedback and computerized cancer screening reminders were aimed at physicians directly, and one, patient education, indirectly through their patients. While all three interventions were acceptable to the physicians, implementation of the audit with feedback intervention was logistically more difficult and more costly than either the cancer screening reminders or patient education interventions. The average cost per additional screening test (beyond the number that would have been performed without intervention) was $50.40 for audit with feedback, $18.19 for cancer screening reminders, and $51.20 for patient education. Overall, the cancer screening reminder intervention was the most feasible of the three strategies.