Abstract
Background: In developing effective interventions to increase colorectal
cancer (CRC) screening in at risk populations, a necessary first requirement is
feasibility. This paper describes how the RESPECT approach to health education
guided the conceptualization and implementation of physician-directed academic
detailing (AD) to increase practice-wide CRC screening uptake.
Methods: Physician-directed
AD was one intervention component in a large educational randomized controlled
trial to increase CRC screening uptake. Study participants, primarily urban
minority, were aged 50 or older, insured for CRC screening with no
out-of-pocket expense and out of compliance with current screening
recommendations. The trial was conducted in the New York City metropolitan
area. Participants identified their primary care physician; 564 individuals
were recruited, representing 459 physician practices. Two-thirds of the
physician practices were randomized to receive AD. The RESPECT approach,
modified for AD, comprises: 1) Rapport, 2) Educate, but don’t overwhelm, 3)
Start with physicians where they are, 4) Philosophical orientation based on a
humanistic approach to education, 5) Engagement of the physician and his/her
office staff, 6) Care and show empathy, and 7) Trust. Feasibility was assessed
as rate of AD delivery.
Results: The AD was delivered
to 283 (92.5%) of the 306 practices assigned to receive it; 222/283 (78.4%)
delivered to the doctor.
Conclusion: The
AD was feasible and acceptable to implement across a range of clinical settings. The
RESPECT approach offers a framework for tailoring educational efforts, allowing
flexibility, as opposed to strict adherence to a highly structured script or a
universal approach.