Designing a randomized controlled trial to evaluate a community-based narrative intervention for improving colorectal cancer screening for African Americans.

OBJECTIVE: To describe the methodology of a 2-arm randomized controlled trial that compared the effects of a narrative and didactic version of the Witness CARES (Community Awareness, Reach, & Empowerment for Screening) intervention on colorectal cancer screening behavior among African Americans, as well as the cognitive and affective determinants of screening. METHODS: Witness CARES targeted cognitive and affective predictors of screening using a culturally competent, community-based, narrative or didactic communication approach. New and existing community partners were recruited in two New York sites. Group randomization allocated programs to the narrative or didactic arm. Five phases of data collection were conducted: baseline, post-intervention, three-month, six-month, and qualitative interviews. The primary outcome was screening behavior; secondary outcomes included cognitive and affective determinants of screening. RESULTS: A total of 183 programs were conducted for 2655 attendees. Of these attendees, 19.4% (N=516) across 158 programs (50% narrative; 50% didactic) were study-eligible and consented to participate. Half (45.6%) of the programs were delivered to new community partners and 34.8% were delivered at faith-based organizations. Mean age of the total sample was 64.7years and 75.4% were female. CONCLUSION: The planned number of programs was delivered, but the proportion of study-eligible attendees was lower than predicted. This community-based participatory research approach was largely successful in involving the community served in the development and implementation of the intervention and study.

Colorectal Cancer Screening Preferences among Black and Latino Primary Care Patients.

Colorectal cancer (CRC) screening rates in the U.S. have historically been lower among blacks and Latinos than whites. The advent of a new stool-based test, Cologuard, calls for research to determine which CRC screening test minority individuals might prefer. Ninety black and Latino patients who had undergone screening colonoscopy were personally educated about four CRC screening tests and subsequently asked about their test preference, attributes that influenced preference, and strength of preference. Cologuard (31.1 %) and colonoscopy (64.4 %) were preferred over computerized tomographic colonography and fecal immunochemical tests. Preference was influenced by distinct test attributes. Individuals who selected Cologuard over colonoscopy were more likely to be >60 and have greater strength of test preference. There was an overriding preference for Cologuard and colonoscopy among black and Latino individuals who had undergone screening colonoscopy. To further improve CRC screening in these populations, patient preferences should guide recommendations.