Improving Rates of Repeat Colorectal Cancer Screening
Condition: Colorectal Neoplasms
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      The United States Preventive Services Task Force (USPSTF) recommends colorectal cancer (CRC)
      screening using fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy in adults,
      beginning at age 50 and continuing until age 75. However, rates of CRC screening remain
      inadequate. In 2006, only 60.8% of adults 50 or older reported recent CRC screening.
      Screening rates are even lower among Black and Hispanic populations and in areas with higher
      poverty rates. Annual or biennial FOBT testing over many years is essential for FOBT to be
      effective. Few studies have examined the rate of repeat FOBT testing; to the investigators
      knowledge, none have been conducted in populations with high prevalence of barriers to
      screening (e.g., low literacy, varied cultural norms, and transportation difficulties). The
      assumption that FOBT is an effective CRC screening strategy presumes it will be done at least
      biennially, and cost-effectiveness studies of CRC screening strategies have found that the
      results are sensitive to the rate of adherence. The investigators study will provide critical
      information for providers and policymakers as they consider optimal strategies to increase
      CRC screening among vulnerable populations.

      Overall Study Goal: Improve colorectal cancer screening by increasing rates of repeat fecal
      occult blood testing (FOBT).

      Aim 1: Test if a multifaceted intervention increases repeat FOBT testing adherence over a
      30-month period

      Hypothesis 1: Compared to usual care, the intervention will increase the proportion of
      patients who complete a repeat annual FOBT within 6 months of their due date.

      Hypothesis 2: Compared to usual care, the intervention will increase the proportion of
      patients who complete 2 additional FOBTs over the 30-month intervention period.

      Aim 2: Explore perceived barriers to screening among patients who received the intervention
      but did not complete repeat FOBT testing within 18 months

      Aim 3: Assess the costs of the intervention and the costs per additional repeat screening
      compared to patients who received usual care.
    


Intervention name(s): Reminder and Outreach Intervention
Intervention type(s): Behavioral
Intervention description(s): This intervention includes (1) phone calls and text messages to remind participants that they are due for colorectal cancer (CRC) screening (2) mailed fecal occult blood test (FOBT) to participants so they can perform the test conveniently at home and mail them to the clinic, avoiding the need for a visit (3) plain language information and instructions to support understanding of CRC and FOBT use (4) a CRC screening coordinator to contact those still failing to complete testing by telephone or text (5) a feedback loop to patients regarding test results.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Screening
Keywords: Colorectal Cancer Screening; Fecal Occult Blood Testing