Mailed Outreach With Enclosed Testing Kit Improves CRC Screening Adherence

Sending patients a fecal immunohistochemical test (FIT) or guaiac-based fecal occult blood test (gFOBT) can improve colorectal cancer (CRC) screening rates in clinical settings that serve a high proportion of low-income patients, according to a study published in Preventive Medicine.

“In this meta-analysis, we found that mailing patients information about CRC with a reminder to undergo CRC screening is an effective intervention that significantly increases CRC screening in low-income settings compared to usual care,” wrote corresponding author Christian Okitondo, a PhD student at the University of Georgia College of Public Health, Athens, Georgia, and study coauthors. “Furthermore, including a FIT or gFOBT test kit in the mailed outreach significantly increases the likelihood that a patient undergoes CRC screening compared to outreach without an enclosed FIT test.”

The systematic review and meta-analysis included 46 randomized controlled trials that investigated interventions for increasing CRC screening in low-income settings in the United States.

According to the study, mailed outreach and patient navigation were the most effective strategies. Random-effects meta-analysis identified the following relative risks for the effectiveness of each intervention: 4.34 for mailed outreach with an enclosed gFOBT; 2.20 for mailed outreach with an enclosed FIT; and 1.80 for mailed outreach without an enclosed FIT or gFOBT. Patient navigation and nonindividualized education also significantly increased CRC screening, with relative risks for effectiveness of 1.62 and 1.44, respectively.

On the other hand, mailed outreach with a financial incentive for FIT return and individualized education did not significantly improve CRC screening, researchers reported.

When it came to types of CRC screening reminders, phone calls were slightly more effective than letters, the study found. The type of phone calls — personal or automated — did not make a difference.

Reference:
Rubin L, Okitondo C, Haines L, Ebell M. Interventions to increase colorectal cancer screening adherence in low-income settings within the United States: a systematic review and meta-analysis. Prev Med. 2023;172:107522. doi:10.1016/j.ypmed.2023.107522