Comparative Effectiveness of Text + Video vs Text Alone to Prompt Stool-Based Testing for Colorectal Cancer Screening

Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths in the United States. Screening for CRC can be accomplished by mailed fecal immunochemical testing (FIT) outreach. Text-based mailed FIT outreach reminders have been shown to improve FIT return rates, but research is lacking in determining if the addition of instructional videos to text messages could boost FIT return.

The study took place at Kaiser Permanente Northwest. Eligible patients included those 45-75 years old who were due or becoming due for CRC screening. Patients were randomized into 2 groups: 1) text alone: received a standard written text message only, and 2) text + video: received a standard written text and a link to a short instructional video. Patient demographic data, including age, sex, CRC screening status, language, race and ethnicity, and length of Health Plan enrollment, were collected. Cox regression analysis was used to compare completion of FIT 90 and 180 days after randomization between both groups.

A total of 12,346 patients were included in this study, with 6156 randomized in the text alone group and 6190 in the text + video group. Patient demographic data were nearly identical in both groups. No differences were found in the FIT return rates between the text alone group (reference) vs text + video group at 90 days (hazard ratio, 1.02; 95% CI, 0.96-1.07; P = .54) and 180 days (hazard ratio, 1.00; 95% CI, 0.96-1.06; P = .78).

Future research should determine ways of assessing patients' receipt of video + text messages to optimize the effectiveness of text message outreach for CRC.