Related Experiment Video
Updated: May 17, 2026
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening
Ronald E Myers1, Heather Bittner-Fagan, Constantine Daskalakis
1Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut Street, Suite 1014, Philadelphia, PA 19107, USA. ronald.myers@jefferson.edu
Background:
This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer screening adherence and screening decision stage (SDS).
Methods:
Primary care patients (n = 945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n = 312), Standard Intervention (SI) Group (n = 316), or usual care CONTROL GROUP (n = 317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months.
Results:
The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%,
Control Group:
12%), was higher for intervention recipients than controls (P = 0.001 and P = 0.001, respectively), but the two intervention groups did not differ significantly (P = 0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and
Control Group:
+23%) was significantly greater among intervention recipients than controls (P = 0.001 and P = 0.001, respectively), and the intervention group difference approached significance (P = 0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options.
Conclusions:
Both interventions had significant, positive effects on outcomes compared with usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS.
Impact:
Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.