Patient and Physician Reminders to Promote Colorectal Cancer Screening

Abstract

Background Screening reduces colorectal cancer mortality, but effective screening tests remain underused. Systematic reminders to patients and physicians could increase screening rates. Methods We conducted a randomized controlled trial of patient and physician reminders in 11 ambulatory health centers. Participants included 21,860 patients ages 50 to 80 overdue for colorectal cancer screening and 110 primary care physicians. Patients were randomly assigned to receive mailings containing an educational pamphlet, fecal-occult-blood test kit, and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. The primary outcome was receipt of fecal-occult-blood testing, flexible sigmoidoscopy, or colonoscopy over 15 months, and the secondary outcome was detection of colorectal adenomas. Results Screening rates were higher for patients who received mailings compared to those who did not (44.0% vs. 38.1%, p<0.001). The effect increased with age: +3.7% for ages 50-59; +7.3% for ages 60-69; and +10.1% for ages 70-80 (p=0.01 for trend). Screening rates were similar among patients of physicians receiving electronic reminders and the control group (41.9% vs. 40.2%, p=0.47). However, electronic reminders tended to increase screening rates among patients with 3 or more primary care visits (59.5% vs. 52.7%, p=0.07). Detection of adenomas tended to increase with patient mailings (5.7% vs. 5.2%, p=0.10) and physician reminders (6.0% versus 4.9%, p=0.09). Conclusions Mailed reminders to patients are an effective tool to promote colorectal cancer screening, and electronic reminders to physicians may increase screening among adults who more frequently use primary care. (ClinicalTrials.gov ID number NCT00355004)

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

“…Our results support those of previous studies. 11,[22][23][24] Green et al recently found that an automated mailing led to twice as many persons being screened for colorectal cancers. 23 Adding navigated interventions, such as guided support from a registered nurse, led to further improvements in CRC screening rates.…”

“…23 Adding navigated interventions, such as guided support from a registered nurse, led to further improvements in CRC screening rates. 23 Additional studies have also demonstrated the benefit of point of care prompts 11,12 and personal telephone calls to improve cancer screening rates among women. 22 In contrast to personalized outreach and in-reach, we found that automated telephone calls did not provide additional benefit beyond a reminder letter.…”

“…We used paper prompts (Online Appendix 3) because this enabled us to deliver similar prompts to patients and clinicians simultaneously, and because of doubts regarding effects of electronic prompts on clinician screening. 11 Research staff reviewed scheduling modules weekly to check for planned acute and preventive visits by patients in Group #3. Prompts were delivered to the treating clinician at the point of care to remind the patient and provider about overdue screening.…”

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

“…Interventions targeting physicians have included academic detailing, 26,27 chart audit and feedback, 28,29 reminder systems, 30 and communication skills training. 21,29 Pre-visit patient-level interventions in patients of lower socioeconomic status, which have been effective in increasing CRC screening discussions/recommendations, include activation counseling, 31,32 computer-delivered tailored intervention 33 and decision aids.…”