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A Postcard Primer Prior to Mailed Fecal Immunochemical Test Among Veterans: a Randomized Controlled Trial
Stefanie Deeds1,2, Terrence Liu3,4, Linnaea Schuttner3,4
1Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Stefanie.Deeds@va.gov.
Journal of General Internal Medicine
|June 8, 2023
Summary
Advanced notification postcards did not increase colorectal cancer screening completion rates among Veterans using mailed fecal immunochemical testing (FIT). Further strategies are needed to improve FIT program participation and effectiveness.
Area of Science:
- Public Health
- Gastroenterology
- Health Services Research
Background:
- Mailed fecal immunochemical testing (FIT) is a key tool for population-based colorectal cancer (CRC) screening.
- Advanced notifications, or primer postcards, are a common feature in mailed FIT programs, but their effectiveness in Veteran populations is understudied.
Purpose of the Study:
- To evaluate whether a primer postcard sent in advance of a mailed FIT kit increases FIT completion rates among Veterans undergoing average-risk CRC screening.
Main Methods:
- A prospective, randomized quality improvement trial was conducted.
- 2404 Veterans due for average-risk CRC screening were randomized to receive either a mailed FIT kit alone or a primer postcard 2 weeks prior to the mailed FIT kit.
- The primary outcome was FIT completion at 90 days, with a secondary outcome at 180 days.
Main Results:
- Unadjusted FIT return rates at 90 days were similar between the control and primer groups (27% vs. 29%, p=0.11).
- Adjusted analysis indicated that the primer postcard did not significantly increase FIT completion compared to mailed FIT alone (OR 1.14 [0.94, 1.37]).
Conclusions:
- The study found no significant increase in FIT completion rates among Veterans receiving a mailed postcard primer.
- Low overall mailed FIT return rates highlight the need for innovative strategies to enhance participation and improve CRC screening effectiveness in this population.
