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World J Gastrointest Oncol. 2014 Jul 15;6(7):257-62. doi: 10.4251/wjgo.v6.i7.257.

Patient prompting of their physician resulted in increased colon cancer screening referrals.

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Vu Le, Saqib Syed, Kenneth J Vega, Tushar Sharma, Mohammad F Madhoun, Nandakumar Srinivasan, Courtney W Houchen, Division of Digestive Disease and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.



To determine whether a communication instrument provided to patients prior to their primary care physician (PCP) visit initiates a conversation with their PCP about colorectal cancer screening (CRC-S), impacting screening referral rates in fully insured and underinsured patients.


A prospective randomized control study was performed at a single academic center outpatient internal medicine (IRMC, underinsured) and family medicine (FMRC, insured) resident clinics prior to scheduled visits. In the intervention group, a pamphlet about the benefit of CRC-S and a reminder card were given to patients before the scheduled visit for prompting of CRC-S referral by their PCP. The main outcome measured was frequency of CRC-S referral in each clinic after intervention.


In the IRMC, 148 patients participated, a control group of 72 patients (40F and 32M) and 76 patients (48F and 28M) in the intervention group. Referrals for CRC-S occurred in 45/72 (63%) of control vs 70/76 (92%) in the intervention group (P ≤ 0.001). In the FMRC, 126 patients participated, 66 (39F:27M) control and 60 (33F:27M) in the intervention group. CRC-S referrals occurred in 47/66 (71%) of controls vs 56/60 (98%) in the intervention group (P ≤ 0.001).


Patient initiated physician prompting produced a significant referral increase for CRC-S in underinsured and insured patient populations. Additional investigation aimed at increasing CRC-S acceptance is warranted.


Colon cancer; Physician patient relationship; Primary care; Referral; Screening

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