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IU cancer researcher awarded nearly $2.6 million to increase colorectal cancer screening


IU cancer researcher awarded nearly $2.6 million to increase colorectal cancer screening

INDIANAPOLIS — An Indiana University cancer researcher has been awarded nearly $2.6 million to compare interventions to increase colorectal cancer screening among underserved patients with limited resources.

Susan Rawl, PhD, professor of adult health at the IU School of Nursing and a researcher at the Indiana University Melvin and Bren Simon Cancer Center, received the award from the Patient-Centered Outcomes Research Institute (PCORI).

Dr. Rawl and colleagues will compare two interventions — a mailed tailored DVD alone to a mailed tailored DVD plus a telephone-based patient navigator — to usual care to increase colorectal screening rates.

The researchers will target 750 patients between the ages of 50 and 75 who were referred and scheduled to have a colonoscopy, but they either cancelled or did not attend the scheduled appointment. The DVD and the DVD plus the patient navigator are designed to educate people about the importance and benefits of screening as well as provide assistance to overcome each individual’s barriers.

According to Dr. Rawl, patient navigation and computer programs that are personalized to the unique needs of each user have been shown to be effective approaches to increasing colorectal cancer and other cancer screening, but no studies have combined them to examine their effectiveness.

“We will examine whether these interventions improve knowledge about colon cancer and screening and change health beliefs about screening,” Dr. Rawl said. “Ultimately, the goal is to test whether these interventions are effective approaches to getting people screened.”

People do not go to their appointments for a variety of reasons, including a lack of awareness of the need for screening and the benefits of screening, fear of pain, fear of finding cancer, unpleasantness of bowel preparation, cost, transportation issues, and an unwillingness to undergo invasive testing while not experiencing any symptoms.

Colorectal cancer is the third most common cause of cancer deaths in the country. About one-half of the deaths could be prevented if appropriate colon cancer screening was widely implemented.

Screening varies from annual stool testing with fecal occult blood tests or fecal immunochemical tests, sigmoidoscopy every five years, or colonoscopy every 10 years. The effectiveness of any screening depends on the rate of adherence. In 2014, only 41 percent of the people referred for colonoscopy completed the test in a local health system.

“Through this study, we seek to learn how to best educate and motivate people to get a colorectal cancer screening test because it can be a life saver,” Dr. Rawl said. “This study – when completed – has the potential to change how health care providers and health care systems educate, counsel, and prepare patients for screening. Our results may lead them to implement one or both of these interventions in a variety of health systems as a way to increase this much-needed screening.”

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Executive Director Joe Selby, MD, MPH. “We look forward to following the study’s progress and working with Indiana University to share the results.”

Dr. Rawl’s study was selected for PCORI funding through a highly competitive review process in which patients, clinicians, and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria.

Dr. Rawl, director of the nursing school’s National Institute of Nursing Research-funded T32 training program in behavioral nursing research, and director of the PhD in Nursing Science program, is co-leader of the IU Simon Cancer Center’s Cancer Prevention and Control research program. The 50 scientists in the program work to decrease cancer morbidity and mortality and are involved in the prevention and early detection of debilitating symptoms caused by cancer treatment while tailoring cancer treatment to individuals.

Her research interest is focused on behavioral oncology, with a special emphasis on interventions to promote cancer screening and reduce cancer risk. Her studies, funded by the National Cancer Institute and the National Institute for Nursing Research, have tested computer-based, tailored health promotion interventions to motivate colorectal cancer screening.

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit