Effect of Reminder Intervention for Colorectal Cancer Screening

In a community case study in the Michigan Department of Community Health, researchers found that implementing a reminder system for employees to get screened for colorectal cancer (CRC) resulted in a 16% increase in screening rate. The results of the study were released by the Centers for Disease Control and Prevention (CDC).

According to the CDC, CRC is the second leading cause of cancer-related death in the United States among cancers that affect both men and women. CRC is also one of the most commonly diagnosed cancers in the United States. Screening can detect CRC earlier, which is more optimal for successful treatment. Screening is recommended for women and men beginning at 50 years of age.

In Michigan, the American Cancer Society estimated 4730 new cases and 1700 deaths due to CRC in 2013. The Michigan Department of Community health represents 1 of 25 states and 4 tribes to receive a multiyear grant from the CDC to increase CRC screening rates via health interventions and clinical services. The CDC set a goal to increase CRC screening rates to 80% in 2014.

This program in Michigan was implemented using evidence-based public health interventions, which began to evolve <15 years ago. Evidence-based public health interventions include decision-making on the basis of available scientific evidence, data, and information systems and on program planning frameworks; engaging the community in decision-making; and disseminating information that has been learned. Client reminders are an evidence-based public health intervention that the CDC’s CRC Control Program logic model supports in order to increase CRC screening.

The program had 2 primary end points: (1) develop a collaborative partnership with a Michigan Cancer Consortium organization for the pilot intervention; and (2) increase CRC screening rates by implementing the reminder intervention and then measuring the increase in screening rates.

The study partnered with HealthPlus of Michigan, a health and wellness organization that provides customized, nationally recognized health plans. The US Preventive Services Task Force guidelines include the following screening protocols: high-sensitivity fecal occult blood test, flexible sigmoidoscopy, or colonoscopy. People with current or past history of CRC or who had a total colectomy were excluded from the study.

HealthPlus developed a client reminder postcard tailor to organizational needs. The postcards included the following reminder text: “Just a quick reminder. [It is] time for your colorectal cancer screening. If you are 50 [years of age] or older, talk with your healthcare provider about the different colon cancer screening tests.”

A total of 95 HealthPlus employees and their spouses were eligible for and received the reminder intervention, of which 15 completed screening, accounting for a 16% increase in screening rate. Four individuals (4%) completed screening within the first 3 months of receiving the intervention, and an additional 11 people (12%) completed screening after 6 months.

This project was considered successful by the researchers because both of the primary end points were achieved.

The researchers noted that evidence-based public health interventions require building a relationship with a partner organization, incorporating flexibility, and establishing a realistic timeline.