Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Abstract

INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

“…The majority of these studies tested the impact of PN on screening rates for colorectal (n = 32 [67%]), breast (n = 13 [27%]), or cervical cancer (n = 4 [8%]) . Thirty‐nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls . Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non–US‐born urban minority populations .…”

“…10, Thirty-nine articles reported a significant favorable increase in cancer screening rates for PN intervention groups versus controls. 10,[32][33][34][35][37][38][39][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][58][59][60][61][62][64][65][66]69,[71][72][73][74][75][76]78 Thirteen studies (27%) targeted African American, Latino, Korean American, Asian/Pacific Islander, and non-US-born urban minority populations. 42,47,49,50,52,57,58,65,71,72,…”

A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial

“…Multiple studies have demonstrated that mailing fecal tests increases CRC screening uptake, but almost all such studies have evaluated screening after only a 1‐time intervention . There is little information on whether an ongoing mailed program improves screening adherence over time, particularly in a setting in which patients also have access to screening colonoscopy and flexible sigmoidoscopy.…”

“…2 Multiple studies have demonstrated that mailing fecal tests increases CRC screening uptake, but almost all such studies have evaluated screening after only a 1-time intervention. [3][4][5][6][7][8][9][10][11] There is little information on whether an ongoing mailed program improves screening adherence over time, particularly in a setting in which patients also have access to screening colonoscopy and flexible sigmoidoscopy. Long-term adherence to fecal testing might not be as robust as adherence to the other tests because of its annual testing cycle versus testing every 5 or 10 years.…”

Capsule Commentary on Goldman et al., Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

“…T he authors conducted a randomized trial of a multidimensional intervention to enhance colorectal cancer (CRC) screening uptake using fecal occult blood tests (FOBT) in a community health center (CHC) setting for patients who had no evidence of prior screening, 1 building on the author's previous work in which mailings sent to patients in this setting achieved higher CRC screening uptake than a multifaceted practice-level systems-based intervention.…”