(HealthDay News) — Low-cost interventions relying upon mailings, text messages, and phone calls can increase adherence to colorectal cancer screening with fecal immunochemical tests (FIT) among vulnerable populations, according to a study published in JAMA Internal Medicine.
David W. Baker, MD, from Northwestern University in Chicago, and colleagues randomly assigned 450 patients seen in a network of community health centers who had previously completed a home FOBT (March 2011 through February 2012).
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Usual care included computerized reminders, standing orders for FIT tests, and clinician feedback on CRC screening rates. The intervention group additionally received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message FIT reminder; (3) another automated telephone and text reminder 2 weeks later when the FIT was not returned; and (4) personal telephone outreach after 3 months.
The researchers found that intervention patients were much more likely than to complete FOBT (82.2% vs. 37.3%; P < 0.001), compared to those in usual care.
For the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not needed), 39.6% within 2 weeks (after step 1 of intervention), 24.0% (after automated call/text reminder), and 8.4% (after personal call).
“It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies,” the researchers wrote.
Unfortunately, however, only 60% of those with a positive screening FOBT result underwent follow-up diagnostic colonoscopy, noted authors of a related commentary.
“Follow-up colonoscopy is crucial, since the chance of CRC is as high as 4% in individuals with a positive FOBT result, and almost one-third have advanced precancerous adenomas,” they continued.
“Lack of a follow-up colonoscopy defeats the purpose of a FOBT screening program,” they continued. “Baker et al do not describe the reasons for low rates of follow-up diagnostic colonoscopy, but for many people in the United States, the barriers to this procedure are substantial and include limited availability and cost,” they wrote.
- Baker DW, Brown T, Buchanan DR et al. Comparative Effectiveness of a Multifaceted Intervention to Improve Adherence to Annual Colorectal Cancer Screening in Community Health Centers: A Randomized Clinical Trial. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.2352.
- Green BB, Coronado DG. “BeneFITs” to Increase Colorectal Cancer Screening in Priority Populations. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.730.