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Showing content from https://pubmed.ncbi.nlm.nih.gov/24164375/ below:

Evaluation of a home-based colorectal cancer screening intervention in a rural state

Randomized Controlled Trial

Affiliations

• ¹ VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.

• PMID: 24164375
• PMCID: PMC4266988
• DOI: 10.1111/jrh.12052

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Randomized Controlled Trial

Mary E Charlton et al. J Rural Health. 2014 Summer.

• ¹ VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.

• PMID: 24164375
• PMCID: PMC4266988
• DOI: 10.1111/jrh.12052

Item in Clipboard

Purpose: Distance from health care facilities can be a barrier to colorectal cancer (CRC) screening, especially for colonoscopy. Alternatively, an improved at-home stool-based screening tool, the fecal immunochemical test (FIT), requires only a single sample and has a better sensitivity-specificity balance compared to traditional guaiac fecal occult blood tests. Our objective was to determine if FITs mailed to asymptomatic, average-risk patients overdue for screening resulted in higher screening rates versus mailing educational materials alone or no intervention (ie, usual care).

Methods: Veterans ages 51-64, asymptomatic, at average risk for CRC, overdue for screening and in a veterans administration (VA) catchment area covering a large rural population were randomly assigned to 3 groups: (1) education only (Ed) group: mailed CRC educational materials and a survey of screening history and preferences (N = 499); (2) FIT group: mailed the FIT, plus educational materials and survey (N = 500); and (3) usual care (UC) group: received no mailings (N = 500).

Findings: At 6 months postintervention, 21% of the FIT group had received CRC screening by any method compared to 6% of the Ed group (and 6% of the UC group) (P < .0001). Of the 105 respondents from the FIT group, 71 (68%) were eligible to take the FIT. Of those, 64 (90%) completed the FIT and 8 (12%) tested positive.

Conclusions: This low-intensity intervention of mailing FITs to average risk patients overdue for screening resulted in a significantly higher screening rate than educational materials alone or usual care, and may be of particular interest in rural areas.

Keywords: access to care; colorectal cancer screening; fecal immunochemical test; health services research; program evaluation.

© 2013 National Rural Health Association.

PubMed Disclaimer

Conflict of Interest Statement: No financial disclosures were reported by any authors.

Sampling Flowchart

Sampling Flowchart

Sampling Flowchart

FIT Group Screening Rates *…

FIT Group Screening Rates * Study team physician called all ineligible subjects to…

FIT Group Screening Rates * Study team physician called all ineligible subjects to discuss their personal/family medical history or current symptoms and arrange for follow-up as appropriate; a note was also entered into the electronic medical record. Seven of these 34 subjects returned a FIT (2 with potential symptoms and 5 with personal/family histories that may warrant surveillance with colonoscopy) despite instructions not to do so.

• Increasing colorectal cancer screening in an overdue population: participation and cost impacts of adding telephone calls to a FIT mailing program.

  Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Schlichting JA, et al. J Community Health. 2014 Apr;39(2):239-47. doi: 10.1007/s10900-014-9830-1. J Community Health. 2014. PMID: 24499966 Free PMC article.

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• Veterans' Continued Participation in an Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening.

  Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Schlichting JA, et al. J Am Board Fam Med. 2015 Jul-Aug;28(4):494-7. doi: 10.3122/jabfm.2015.04.140241. J Am Board Fam Med. 2015. PMID: 26152441 Free PMC article.

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  Meklin J, Syrjänen K, Eskelinen M. Meklin J, et al. Anticancer Res. 2020 Feb;40(2):575-581. doi: 10.21873/anticanres.13987. Anticancer Res. 2020. PMID: 32014898 Review.

• Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know.

  Tinmouth J, Lansdorp-Vogelaar I, Allison JE. Tinmouth J, et al. Gut. 2015 Aug;64(8):1327-37. doi: 10.1136/gutjnl-2014-308074. Epub 2015 Jun 3. Gut. 2015. PMID: 26041750 Review.

• Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data.

  Davis MM, Renfro S, Pham R, Hassmiller Lich K, Shannon J, Coronado GD, Wheeler SB. Davis MM, et al. Prev Med. 2017 Aug;101:44-52. doi: 10.1016/j.ypmed.2017.05.001. Epub 2017 May 13. Prev Med. 2017. PMID: 28506715 Free PMC article.

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  Mehta SJ, Khan T, Guerra C, Reitz C, McAuliffe T, Volpp KG, Asch DA, Doubeni CA. Mehta SJ, et al. Am J Gastroenterol. 2018 Dec;113(12):1848-1854. doi: 10.1038/s41395-018-0151-3. Am J Gastroenterol. 2018. PMID: 29925915 Free PMC article. Clinical Trial.

• Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis.

  Jager M, Demb J, Asghar A, Selby K, Mello EM, Heskett KM, Lieberman AJ, Geng Z, Bharti B, Singh S, Gupta S. Jager M, et al. Dig Dis Sci. 2019 Sep;64(9):2489-2496. doi: 10.1007/s10620-019-05587-6. Epub 2019 Mar 26. Dig Dis Sci. 2019. PMID: 30915656 Free PMC article.

• Who Performs Colonoscopy? Workforce Trends Over Space and Time.

  Eberth JM, Josey MJ, Mobley LR, Nicholas DO, Jeffe DB, Odahowski C, Probst JC, Schootman M. Eberth JM, et al. J Rural Health. 2018 Mar;34(2):138-147. doi: 10.1111/jrh.12286. Epub 2017 Nov 16. J Rural Health. 2018. PMID: 29143383 Free PMC article.

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