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Research ArticleResearch

ColonCancerCheck Primary Care Invitation Pilot project

Patient perceptions

Jill Tinmouth, Paul Ritvo, S. Elizabeth McGregor, Jigisha Patel, Crissa Guglietti, Cheryl A. Levitt, Lawrence F. Paszat and Linda Rabeneck
Canadian Family Physician December 2013, 59 (12) e541-e549;
Jill Tinmouth
Staff physician at Sunnybrook Health Sciences Centre in Toronto, Ont, Adjunct Scientist for the Institute for Clinical Evaluative Sciences, Assistant Professor at the University of Toronto, and Lead Scientist for the ColonCancerCheck program at Cancer Care Ontario.
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  • For correspondence: jill.tinmouth@sunnybrook.ca
Paul Ritvo
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S. Elizabeth McGregor
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Jigisha Patel
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Crissa Guglietti
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Cheryl A. Levitt
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Lawrence F. Paszat
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Linda Rabeneck
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Article Figures & Data

Tables

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    Table 1.

    Characteristics of FG participants: Percentages do not add to 100% owing to rounding.

    CHARACTERISTICHAMILTON FG1 (N = 11)HAMILTON FG2 (N = 6)OTTAWA FG1 (N = 10)OTTAWA FG2 (N = 10)THUNDER BAY FG1 (N = 11)THUNDER BAY FG2 (N = 10)TOTAL (N = 58)
    Sex, n (%)
      • Male7 (64)2 (33)6 (60)4 (40)5 (45)2 (20)26 (45)
      • Female4 (36)4 (67)4 (40)6 (60)6 (55)8 (80)32 (55)
    Median (IQR) age, y65 (61–69)59 (55–60)60 (53–70)65 (59–66)60 (58–68)60 (58–66)60 (60–63)
    Working, n (%)
      • Yes5 (45)5 (83)5 (50)3 (30)6 (55)5 (50)29 (50)
      • No6 (55)1 (17)5 (50)7 (70)5 (45)5 (50)29 (50)
    Education, n (%)
      • High school or less8 (73)2 (33)2 (20)0 (0)4 (36)2 (20)18 (31)
      • Some college or university0 (0)1 (17)1 (10)0 (0)2 (18)1 (10)5 (9)
      • Completed college or university3 (27)3 (50)7 (70)10 (100)5 (45)5 (50)33 (57)
      • Unknown0 (0)0 (0)0 (0)0 (0)0 (0)2 (20)2 (3)
    Ethnicity, n (%)
      • White11 (100)6 (100)9 (90)8 (80)10 (91)8 (80)52 (90)
      • Native Canadian or aboriginal0 (0)0 (0)0 (0)0 (0)1 (9)0 (0)1 (2)
      • Mixed (black and white)0 (0)0 (0)1 (10)0 (0)0 (0)0 (0)1 (2)
      • South Asian0 (0)0 (0)0 (0)1 (10)0 (0)1 (10)2 (3)
      • Middle Eastern0 (0)0 (0)0 (0)1 (10)0 (0)0 (0)1 (2)
      • Asian0 (0)0 (0)0 (0)0 (0)0 (0)1 (10)1 (2)
    Type of previous screening,* n (%)
      • FOBT8 (73)2 (33)7 (70)3 (30)5 (45)4 (40)29 (50)
      • Colonoscopy0 (0)1 (17)0 (0)1 (10)0 (0)0 (0)2 (3)
      • FOBT and colonoscopy2 (18)0 (0)3 (30)4 (40)0 (0)1 (10)10 (17)
      • Screened, exact test not known0 (0)0 (0)0 (0)1 (10)5 (45)2 (20)8 (14)
      • None0 (0)3 (50)0 (0)1 (10)0 (0)2 (20)6 (10)
      • Previous screening history unknown1 (9)0 (0)0 (0)0 (0)1 (9)1 (10)3 (5)
    • FG—focus group, FOBT—fecal occult blood testing, IQR—interquartile range.

    • * Patients were asked about any previous screening, not just screening related to the ColonCancerCheck Primary Care Invitation Pilot.

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    Table 2.

    Participants’ attitudes toward the ColonCancerCheck Primary Care Invitation Pilot

    THEMESELECTED QUOTATIONS FROM FG PARTICIPANTS
    Invitation letter reaction
    • I don’t remember … I have everything filed and I went through the medical file and I can honestly say that, as far as I know, 100% I did not see this letter. (FG1, Ottawa, Ont)

    • My doctor for the last 2 years has been mentioning that I should do one of those kits and I’m a procrastinator and I don’t go and pick it up. I saw this [letter] and I thought, “Oh yeah, I’ve got to pick that up.” (FG2, Thunder Bay, Ont)

    • My doctor just said you’re at that age and you should go get this done … he’s pretty knowledgeable so I thought, “Yeah, this is a good idea.” So when it [the letter] came in the mail, I read the stuff. So it reinforced me. His opinion reinforced the process. (FG1, Thunder Bay)

    • [It] came out of the blue. I’m wondering why the doctor that … never talks to you much … sends … a letter saying you should come in and talk about … colonoscopy. I was in a … state of panic: “What’s going on here; what isn’t he saying?” (FG2, Thunder Bay)

    • What threw me off was, “Please call my office for an appointment,” because I had just been there and thought, “Who’s this letter from, actually?” (FG2, Hamilton, Ont)

    • [I did] exactly what I do to any mail-out I get, I put it in a little pile ... and never see it any more. (FG1, Hamilton)

    • I wouldn’t have even brought it up to my family physician if I hadn’t received the letter. That’s what I needed—a trigger. (FG2, Hamilton)

    • I remember getting it and it was very clear and I acted on it. (FG1, Ottawa)

    Suggestions about changing the invitation letter format and content
    • If the doctor’s name hadn’t been on the bottom I’d … give it a toss. (FG1, Thunder Bay)

    • The fact that your own doctor’s name is on there, makes it a little more personal. (FG1, Hamilton)

    • [I found it] very confusing that it’s coming from my doctor … [it] should be coming … from Cancer Care Ontario … and … say, “On behalf of your doctor.” (FG1, Ottawa)

    • Put … in the first paragraph ... [that] it’s a simple test that can be done at home. (FG1, Hamilton)

    • If the letter is going to work, it’s got to be more scary … powerful … you need to give people something to grab onto at the very beginning like … that this simple little test could save your life. (FG1, Ottawa)

    • I like lots of information. There wasn’t enough information in this for me. (FG1, Thunder Bay)

    • I still was wondering how prevalent it [colorectal cancer] was and I was thinking it would be nice to know that ... to know it [screening] was something that would make a difference or not. (FG1, Thunder Bay)

    • It says I’ve missed the FOBT … and then you should have a … colonoscopy. Now it says if you’re at risk … you really should have [a colonoscopy] but if I’m average do I still get one? (FG2, Thunder Bay)

    FOBT responses and experiencesMotivators to use FOBT
    Personal health factors
    • [I am] getting older … a few years ago I didn’t want to … but now I do. (FG1, Thunder Bay)

    • I have family that has colon cancer. (FG1, Thunder Bay)


    Social factors
    • My wife wanted me to. (FG2, Hamilton)

    • [I have] relatives that had cancer ... and my husband’s sister died of colon cancer … so did his father. That’s enough … fear … for me to do the screening … going to be safe [rather] than sorry. (FG1, Thunder Bay)

    • I needed a little push, which I got from my union and I got from this letter. (FG1, Hamilton)


    Health system interventions
    • My physician … directed me to have the stool test. (FG1, Ottawa)

    • My doctor just gave me this kit, I did the test and … put it in the mailbox. (FG2, Thunder Bay)

    • I saw the commercial on TV, so I asked my doctor for the envelope to do the stool test. (FG1, Ottawa)

    • I can honestly say I would have never have gone if I didn’t get this letter … it was a trigger that reminded me. (FG1, Ottawa)


    Barriers to FOBT
    • Once you got past the yuck factor … it was pretty simple. (FG1, Hamilton)

    • I didn’t really like the whole process … I thought, “That’s disgusting.” (FG2, Hamilton)

    • What bothered me more was what I could eat or not eat. (FG1, Hamilton)

    • It’s like a fear thing … if I do the FOBT and something shows up … then I have a colonoscopy. (FG2, Hamilton)


    Receiving results
    • I don’t remember getting the results. (FG1, Ottawa)

    • I thought since I sent in the test that I would get results but then I thought, “Well, maybe my doctor got the results,” and since she never … they never call if it’s negative. (FG1, Ottawa)

    • The first time I had … [FOBT] done and he [physician] called me into the office to say it was negative and I said, “Well, that’s a waste of time.” So, this time when I did get [the results] in the letter form, I felt it was better because I wasn’t wasting up valuable doctor time. (FG1, Ottawa)

    Direct mailing of FOBT kit
    • If ... kits are sent … directly, you’d have a lot more people participating. (FG1, Hamilton)

    • If it [the kit] would come in the mail, I’d say, “Oh, I got this, I’d better do it.” (FG1, Thunder Bay)

    • If they sent me the kit the first time I wouldn’t have done it … because I’ve done it once, I’ll do it again. (FG1, Thunder Bay)

    • My doctor gets me all the tests … more tests than I want already and I don’t need this. It’s a waste, sending it to me. (FG2, Ottawa)

    Screening promotion strategiesStrategies that would be novel to the ColonCancerCheck program
    • If you use the educational system to get the information out, also you’re going to reach the parents of these children that are [minority] ethnic cultures. (FG2, Ottawa)

    • Gyms and sporting areas. That’s big … getting fit again. Health clubs, gymnasiums ... (FG1, Ottawa)

    • The Internet. That’s what everybody’s looking at. (FG1, Hamilton)

    • What about … e-mail, with a link to a website that has some testimonials of people that had the test, didn’t have the test, what it

      feels [like]. (FG2, Hamilton)

    • They are the minority so maybe something specific to get males to go might be [a possible strategy]. (FG2, Thunder Bay)


    Strategies previously or currently used by program
    • Oh, maybe part of the medical … just automatically give you the kit at your yearly medical. (FG2, Thunder Bay)

    • When you’re standing at the pharmacy waiting for your prescription to be picked up, if something like this could be there. (FG2, Ottawa)

    • If you could have them hand them [FOBT kits] out with the prescriptions, put one in with the prescriptions. (FG1, Thunder Bay)


    Birthday invitation
    • Sure, I think that would be a good idea because a lot of people … reach 50 and they don’t realize that that’s the time you start all these preventative tests. There’s a whole list of things you could do when you turn 50 [that] would be good. (FG1, Thunder Bay)

    • It kind of smacks of Cracker Barrel … [a] little cheesy. (FG2, Hamilton)

    • FG—focus group, FOBT–fecal occult blood testing.

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Canadian Family Physician: 59 (12)
Canadian Family Physician
Vol. 59, Issue 12
1 Dec 2013
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ColonCancerCheck Primary Care Invitation Pilot project
Jill Tinmouth, Paul Ritvo, S. Elizabeth McGregor, Jigisha Patel, Crissa Guglietti, Cheryl A. Levitt, Lawrence F. Paszat, Linda Rabeneck
Canadian Family Physician Dec 2013, 59 (12) e541-e549;

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ColonCancerCheck Primary Care Invitation Pilot project
Jill Tinmouth, Paul Ritvo, S. Elizabeth McGregor, Jigisha Patel, Crissa Guglietti, Cheryl A. Levitt, Lawrence F. Paszat, Linda Rabeneck
Canadian Family Physician Dec 2013, 59 (12) e541-e549;
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