Fecal Immunochemical Tests for Colorectal Cancer Screening: Mailed Outreach Outperforms In-Clinic Outreach With Phone Calls Being the Most Effective Reminder Strategy.

Abstract

Goals: This study aimed to (1) compare colorectal cancer (CRC) screening rates among patients receiving mailed fecal immunochemical testing (FIT) versus in-clinic FIT and (2) assess the impact of various reminder interventions versus no extra reminder on mailed FIT completion.

Background: FIT is a first-line method for CRC screening. However, no research has compared screening completion in patients receiving FIT through mail (mailed FIT) versus patients receiving FIT from a provider in a clinic setting (in-clinic FIT), both of which have significantly different workflows. Furthermore, limited research has compared whether varying reminder strategies improve mailed FIT completion.

Study: This quality improvement prospective cohort study conducted at the Providence Veterans Affairs Medical Center included patients due for average-risk CRC screening. Sixteen hundred patients were mailed FIT, and if FIT was not returned within 1 month they were randomized to the following reminders: no extra reminder, personal phone call, personal voicemail, mailed postcard. Simultaneously, 1769 patients received in-clinic FIT. Three-month return and result rates were compared between mailed versus in-clinic FIT, as well as across the different mailed FIT reminder interventions.

Results: Mailed FIT return (36%) and result (34%) rates were significantly higher than in-clinic FIT return (28%) and result (24%) rates (both P<0.0001). Phone calls were the most effective mailed FIT reminder (29% return rate), significantly outperforming the no extra reminder group (21% return rate, P=0.02).

Conclusions: Mailed FIT demonstrated higher efficacy and should be implemented in conjunction with in-clinic FIT. Phone call reminders should be incorporated into the mailed FIT workflow.