Colon cancer is a silent killer. Its symptoms appear only after it has reached an advanced stage. But when caught early, the disease is highly curable.
Unfortunately, some groups are less likely to get screened for colon cancer, a disparity that makes the disease a disproportionate killer, as well.
Latinos in the United States are among the groups more likely to be diagnosed with colon cancer at advanced stages and, as a consequence, are more likely to die from the disease.
"Latinos nationally have half the rate of colon cancer screenings as non-Latinos," says Anthony Jerant, associate professor of family and community medicine at UC Davis. "So far traditional educational approaches such as pamphlets and public service announcements have failed to narrow that gap."
Jerant is tackling the problem as the principal investigator on a study that begins in January. With a grant from the National Cancer Institute, Jerant hopes to find out if an interactive multimedia computer software program that personalizes the educational information can boost colon cancer screening rates among Hispanic patients.
"There have been no studies to my knowledge looking at whether by tailoring to people's baseline knowledge, needs and perceptions, we can help level the playing field and reduce health-care disparities," he says. "If that pans out, it would be important, because there's very little evidence so far that health-care interventions can lessen disparities."
The project adapts an earlier version of the software piloted at UC Davis in 2005. The new study will evaluate its impact in the primary-care offices of physicians in the UC Davis Medical Group, as well as in several federally qualified community health centers in New York City and Rochester, N.Y.
"Our initial outcomes with an English-language version of the software were very promising," Jerant says. "Now we can use it and the Spanish-language version at more sites and truly put it to the test in determining whether or not it can improve screening among both English- and Spanish-speaking Latinos."
Jerant and colleague Peter Franks, professor of family and community medicine, were inspired to develop the program after finding disparities in colon cancer screening and a failure of traditional methods of communication to reach patients about its importance.
In one study published last year in the Archives of Internal Medicine, the two UC Davis researchers revealed that blacks, Asians and Latinos were less likely to undergo colorectal cancer screening than whites. Their findings suggested that improved access to care and, for Latinos, providing care and information in their preferred language, could greatly increase screening rates.
In another study published in the Journal of General Internal Medicine, the UC Davis researchers suggested a need for different methods to increase screening among Latino subgroups. They concluded that personally tailored interventions, provided within a culturally salient framework in the patient's preferred language, could mitigate screening rate disparities.
"You can improve some patients' knowledge by giving them a pamphlet or CD, but it tends not to change their behavior," Jerant explains. "What is more likely to change their behavior is making sure the information they get is relevant to what their concerns are."
The interactive software program uses a combination of text, narration, video clips and animation in English and Spanish to address perceived barriers to screening.
The program is interactive in that its messages are tailored to address the patients' responses to questions. For example, if a patient indicates fear that screening is painful, the program responds with information about the procedure to address the concerns. The program explains that some people may experience pain, but that for most it is minimal and that sedatives are used to alleviate discomfort.
"One of the major differences in this software program is that it is offered right in the patients' own doctors' offices, when they may already be thinking about their health and have time to talk with their physicians," Jerant says.
The study, co-managed by Christina Slee and Dionne Evans Dean, will collect data from at least 1,344 patients ages 50 and older in California and New York over an 18-month period.
Information from Latino patients will be compared with information from non-Latino patients to determine if the software helps improve participation in screening overall and, specifically, if it helps reduce or eliminate disparities between these groups. If shown to be effective, the software eventually could be made available widely in physicians' offices.
Kurt Slapnik, medical director of UC Davis' Primary Care Network, sees the project as a tremendous opportunity for both physicians and patients.
"This allows the Primary Care Network to be exposed to the research and teaching components of UC Davis Health System," says Slapnik, who also sees patients in UC Davis' Medical Group office in Folsom. "Patients will be brought in a little early for their regular appointment and will be educated about colorectal cancer screening, with the idea that it will break down the barriers to getting this screening done. By the time they see their primary-care physician, they will be more ready to discuss screening, and it will make the whole process much easier for everyone."
