Improving Colorectal Cancer Screening in a Rural Setting: A Randomized Study

Hirko, Kelly A.; Lennon, Sue A.; Lucas, Todd; Miller, David C.; Jimbo, Masahito; Leibfritz, Stephanie J.; Knoff, Suzanne J.; Janney, Carol A.; Berg, Paul D.

doi:10.1016/j.amepre.2020.03.019

Cited by 6 publications

(17 citation statements)

References 46 publications

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“…While the rural health disparities observed in this study present substantial public health challenges, it is possible to improve cancer outcomes through appropriate public health interventions. For example, a 2020 study found that a mailed motivational message with contact information to request a free at-home fecal immunochemical screening test (compared with a mailed reminder to schedule a screening appointment) effectively improved adherence to screening guidelines in a rural community. An evaluation of patient navigation program in rural Georgia found the program dramatically improved the odds of adherence with colorectal screening guidelines among participants .…”

Section: Discussionmentioning

confidence: 99%

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

et al. 2021

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IMPORTANCE Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas.OBJECTIVES To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. DESIGN, SETTING, AND PARTICIPANTSThis population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. MAIN OUTCOMES AND MEASURES Adherence to cancer screening based on the US PreventativeServices Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. RESULTSThe overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.

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Section: Discussionmentioning

confidence: 99%

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

et al. 2021

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“…Arnold et al 45 found that follow‐up phone calls (either automated or personal) following mail return of fecal immunochemistry test (FIT) kits were associated with improved screening returns among rural residents. Use of mailings and automated phone calls was also associated with increased CRC screening rates for participants in a safety‐net primary care practice, 46 as well as rural residents 47 . Goldman et al 48 also found that use of text messages and automated phone calls, combined with a personal call from a patient navigator for those overdue for cancer screening at 3‐months, increased FIT return rates compared to usual care.…”

Section: Resultsmentioning

confidence: 98%

“…Use of mailings and automated phone calls was also associated with increased CRC screening rates for participants in a safety-net primary care practice, 46 as well as rural residents. 47 Goldman et al 48 also found that use of text messages and automated phone calls, combined with a personal call from a patient navigator for those overdue for cancer screening at 3-months, increased FIT return rates compared to usual care. Use of serial text messages versus a single text message was 17.3% more effective for improving FIT return rates among a largely Black/African American sample.…”

Section: Resultsmentioning

confidence: 99%

Cancer‐Specific health equity metrics in the United States of America: A scoping review

et al. 2023

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“…Along with FIT mail-out intervention, additional strategies were used to improve the FIT completion rate. Uptake increased when using a mailed motivational invitation letter for screening, followed by mailing a cost-free FIT kit in comparison to the group receiving standard invitation letter with no kit (30.1% versus 22.5%) [41]. FIT completion rates were higher among participants who received at least one live interaction via phone call compared to those who had none (27.8% versus 10.5%, p < 0.001) [46].…”

Section: Methods Of Delivery For Fit: Mail-out and In-personmentioning

confidence: 99%

“…Interventions utilizing motivational messages on FIT screening improved participation, particularly in medically-underserved communities (24.6% among those who received the message at least once versus 3% among those who did not receive the message) [46] and rural areas (7.6% increase in intervention group vs control group) [41]. Motivational interviewing techniques (discussing the relevance of CRC screening and exploring participants' feelings about the test) were embedded in live telephone outreach with trained program champions [46] and motivational messaging (highlighting the preventability of CRC and ease and affordability of FIT screening) was incorporated into a mailed invitation letter that addressed barriers in screening [41]. In a study on loss-framed messaging (i.e., emphasizing the life costs of not being screened), participants receiving culturally-targeted loss-framed messaging (addressing cultural needs) were signi cantly more receptive to obtaining CRC screening compared to standard lossframing [44].…”

Section: Delivery Of Culturally-tailored Programsmentioning

confidence: 99%

Effective Strategies for Fecal Immunochemical Tests (FIT) Programs to Improve Colorectal Cancer Screening Uptake Among Populations with Limited Access to the Healthcare System: A Rapid Systematic Review

Belon,

McKenzie,

Teare

et al. 2023

Preprint

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Background Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access.Methods We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed.Results Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex).Conclusions Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.

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Improving Colorectal Cancer Screening in a Rural Setting: A Randomized Study

Cited by 6 publications

References 46 publications

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

Cancer‐Specific health equity metrics in the United States of America: A scoping review

Effective Strategies for Fecal Immunochemical Tests (FIT) Programs to Improve Colorectal Cancer Screening Uptake Among Populations with Limited Access to the Healthcare System: A Rapid Systematic Review

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