Search tips
Search criteria 


Logo of bmjThe BMJ
BMJ. 1992 March 14; 304(6828): 687–691.
PMCID: PMC1881551

Cancer: improving early detection and prevention. A community practice randomised trial.


OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Coulter A, Schofield T. Prevention in general practice: the views of doctors in the Oxford region. Br J Gen Pract. 1991 Apr;41(345):140–143. [PMC free article] [PubMed]
  • Anda RF, Remington PL, Sienko DG, Davis RM. Are physicians advising smokers to quit? The patient's perspective. JAMA. 1987 Apr 10;257(14):1916–1919. [PubMed]
  • Dunn EV, Bass MJ, Williams JI, Borgiel AE, MacDonald P, Spasoff RA. Study of relation of continuing medical education to quality of family physicians' care. J Med Educ. 1988 Oct;63(10):775–784. [PubMed]
  • Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO. Improving physician performance through peer comparison feedback. Med Care. 1984 Jun;22(6):527–534. [PubMed]
  • Weingarten MA, Bazel D, Shannon HS. Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract. 1989 Jun;6(2):120–124. [PubMed]
  • McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH. Promoting cancer prevention activities by primary care physicians. Results of a randomized, controlled trial. JAMA. 1991 Jul 24;266(4):538–544. [PubMed]
  • Chomet J, Chomet J. Cervical screening in general practice: a "new" scenario. BMJ. 1990 Jun 9;300(6738):1504–1506. [PMC free article] [PubMed]
  • Fullard E, Fowler G, Gray M. Facilitating prevention in primary care. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1585–1587. [PMC free article] [PubMed]
  • Fullard E, Fowler G, Gray M. Promoting prevention in primary care: controlled trial of low technology, low cost approach. Br Med J (Clin Res Ed) 1987 Apr 25;294(6579):1080–1082. [PMC free article] [PubMed]
  • Mant D, McKinlay C, Fuller A, Randall T, Fullard EM, Muir J. Three year follow up of patients with raised blood pressure identified at health checks in general practice. BMJ. 1989 May 20;298(6684):1360–1362. [PMC free article] [PubMed]
  • Stampfer MJ, Buring JE, Willett W, Rosner B, Eberlein K, Hennekens CH. The 2 x 2 factorial design: its application to a randomized trial of aspirin and carotene in U.S. physicians. Stat Med. 1985 Apr-Jun;4(2):111–116. [PubMed]
  • Butrum RR, Clifford CK, Lanza E. NCI dietary guidelines: rationale. Am J Clin Nutr. 1988 Sep;48(3 Suppl):888–895. [PubMed]
  • Dickey LL, Petitti D. Assessment of a patient-held minirecord for adult health maintenance. J Fam Pract. 1990 Oct;31(4):431–438. [PubMed]
  • Donner A, Birkett N, Buck C. Randomization by cluster. Sample size requirements and analysis. Am J Epidemiol. 1981 Dec;114(6):906–914. [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group