Study shows that targeted patient outreach can improve colon cancer screening rates
An intensive outreach program targeting vulnerable patients dramatically improved screening rates for colorectal cancer, according to a new study supported by the Agency for Healthcare Research and Quality (AHRQ). The study indicates that comprehensive outreach programs run through community health centers hold great promise in reducing preventable deaths due to colorectal cancer.
The study is published in the June 16 issue of JAMA Internal Medicine. Its authors found that community health center patients who received outreach via mail, automated phone and text messages and calls by a health center staff member were more than twice as likely to complete an at-home colon cancer screening test. This was the case even though most patients in the study were poor and uninsured, and had limited English proficiency and low understanding of health information.
"Early screening is an important tool in fighting colorectal cancer, but only three fifths of U.S. adults age 50 to 75 overall are up to date on their screenings—and serious disparities persist by income, education, race/ethnicity and other groups," said AHRQ Director Richard Kronick, Ph.D. "Today's report indicates that intense outreach can increase screening and save lives."
Colorectal cancer is the third most common cancer for men and women, and the second-leading killer among cancers in the United States overall. Screening and early treatment can be extremely successful in preventing colorectal cancer deaths; approximately 90 percent of people with such cancers that are found early and treated appropriately are still alive five years later.
There are several recommended ways to screen for colorectal cancer, including colonoscopy, sigmoidoscopy, and fecal occult blood test (FOBT). In the United States, the majority of screening is by colonoscopy, even though the procedure is expensive and invasive. Expanded use of FOBT may help to increase rates of colorectal cancer screening, especially among people who face barriers to colonoscopy.
FOBT can be completed at home with a single stool sample. However, the test must be done yearly to be effective, and many people do not complete the test every year. Outreach systems like the one tested in this study should make it possible to achieve high rates of annual use, the study's authors said.
The goal of the study was to determine the effectiveness of an intervention to encourage more people to take the FOBT annually. In the study, researchers led by David W. Baker, M.D., M.P.H., of the Center for Advancing Equity in Clinical Preventive Services, at the Feinberg School of Medicine, Northwestern University, Chicago, identified 450 patients who received their care through a network of community health centers in Chicago. Community health centers are neighborhood clinics that provide community-based care; they typically serve inner city and rural patients. Most of the patients studied were uninsured Hispanic women, and all had had a negative result with a previous at-home FOBT.
The patients were divided into a usual care group and an intervention group. Usual care included computerized reminders, standing orders to give patients home tests and feedback to providers on their screening rates. The intervention group received usual care plus:
- A mailed reminder letter, a free home test with low-literacy instructions and a postage-paid return envelope.
- Automated phone and text messages reminding them that they were due for screening and that a home test was being mailed to them.
- Automated phone and text reminders two weeks later for those who did not return the home test.
- Personal outreach from a trained professional after three months if a test was not completed.
The researchers found that the intervention was very successful, with 82.2 percent of the patients in the intervention group completing the FOBT within six months of the screening due date versus 37.3 percent of the patients in the usual care group.
"This intervention greatly increased adherence to annual colorectal cancer screening," Dr. Baker said. "It is possible to improve annual screening for vulnerable populations with relatively low-cost strategies, and we know that earlier screening will save lives."
AHRQ is a research agency within the U.S. Department of Health and Human Services (HHS). Its mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used. For more information, visit www.ahrq.gov.