A system-based intervention to improve colorectal cancer screening uptake

Area of Science:

• Public Health
• Preventive Medicine
• Gastroenterology

Background:

• Colorectal cancer screening is crucial for early detection and improved patient outcomes.
• Traditional visit-based screening methods often face challenges in achieving high patient adherence.
• Guaiac-based fecal occult blood tests (gFOBTs) are a common screening tool.

Purpose of the Study:

• To compare the effectiveness of mailed guaiac-based fecal occult blood tests (gFOBTs) versus visit-based screening for colorectal cancer.
• To determine if direct mailing of gFOBTs enhances screening uptake among eligible patients.

Main Methods:

• A comparative effectiveness analysis was conducted using electronic medical records.
• A randomized controlled trial identified patients due for screening, with an intervention group receiving mailed gFOBTs.
• Control groups received only visit-based screening; screening uptake was compared using multivariate logistic regression.

Main Results:

• Mailed gFOBTs achieved a 48.5% screening rate, significantly higher than visit-based screening in control groups (14.3%–18.6%).
• Adjusted odds ratios for screening were substantially lower in all control groups compared to the mailed gFOBT intervention group (aORs 0.19–0.25).
• The study demonstrated a statistically significant difference in screening uptake across all groups (P <.001).

Conclusions:

• Directly mailing guaiac-based fecal occult blood tests (gFOBTs) to patients eligible for colorectal cancer screening increases screening uptake.
• Utilizing electronic medical records to identify and target patients for mailed screening is an effective strategy.
• This approach offers a more successful method for enhancing colorectal cancer screening rates compared to visit-based strategies.