Systems of support to increase colorectal cancer screening and follow-up rates (SOS): Design, challenges, and baseline characteristics of trial participants

Abstract

Background Screening decreases colorectal cancer (CRC) morbidity and mortality, yet remains underutilized. Screening breakdowns arise from lack of uptake and failure to follow-up after a positive screening test. Objectives Systems of Support to Increase Colorectal Cancer Screening and Follow-up (SOS) is a randomized trial designed to increase: (1) CRC screening and (2) follow-up of positive screening tests. The Chronic Care Model and the Preventive Health Model inform study design. Methods The setting is a large nonprofit healthcare organization. In part-1 study, patients age 50-75 due for CRC screening are randomized to one of 4 study conditions. Arm 1 receives usual care. Arm 2 receives automated support (mailed information about screening choices and fecal occult blood tests (FOBT)). Arm 3 receives automated and assisted support (a medical assistant telephone call). Arm 4 receives automated, assisted, and care-management support (a registered nurse provides behavioral activation and coordination of care). In part-2, study patients with a positive FOBT or adenomas on flexible sigmoidoscopy are randomized to receive either usual care or nurse care-management. Primary outcomes are: 1) the proportion with CRC screening, 2) the proportion with a complete diagnostic evaluation after a positive screening test. Results We sent recruitment letters to 15,414 patients and 4,675 were randomized. Randomly assigned treatment groups were similar in age, sex, race, education, self-reported health, and CRC screening history. Conclusions We will determine the effectiveness and cost-effectiveness of stepped increases in systems of support to increase CRC screening and follow-up after a positive screening test over 2 years.

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial (Preprint)

“…The interventions were effective for short-term but not long-term, follow-up. Several studies have described interventions aimed at increasing follow-up rates and showed mixed results [13,19,[27][28][29][30][31][32][33][34][35][36][37][38][39][40]. When the patient and physician's relations are good and based on clear communication and trust, the patient will be more likely to adhere to and fulfill the physicians' instructions [41,42].…”

Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

“…Some active intervention participants who did not screen after they received the mailed interventions received further support to complete CRC screening (brief phone assistance from a medical assistant, or this plus nurse navigation). A full description of the study design and results of the initial 2 year and subsequent 3 year interventions have been published [9,10,17].…”

“…Systems of Support to Increase Colorectal Cancer Screening (SOS) is an ongoing four-arm randomized trial that compares usual care (arm-1) to stepped intensity interventions that include more resources for each step: mailings alone (arm-2, a pamphlet about CRC screening choices, a number to call if colonoscopy or flexible sigmoidoscopy was preferred, and mailed fecal kits for those not calling); mailings plus telephone-based brief assistance (arm-3); or mailings, brief assistance, and more intense telephone-based nurse navigation [9]. Adherence to CRC screening over two years of the study was more than double that of usual care (51% to 65% depending on intervention intensity vs. 26% in usual care; P < .001) [10].…”

Care Technologies in Nursing for People with Colorectal Neoplasia: Integrative Review

“…One of them approaches an intervention that make records of the patients that must be tracked, with the goal to ensure the referral process to the treatment and preparation of the patients to a complete the diagnostic test [44].…”