Serial SMS Reminders and an Opt-out Mailed FIT Kits to Improve Colorectal Screening Participation: A Single Center RCT
Condition: Bowel Cancer; Colon Cancer
MeSH terms: Colonic Neoplasms
Study type: Interventional

Summary: 
      This pilot study is a 2-armed randomized controlled trial assessing the impact of a
      multimodal approach on colorectal cancer screening participation rates in a Federally
      Qualified Health Center. The trial will test serial text message reminders and opt-out mailed
      fecal immunochemistry test (FIT) home kits against a simple reminder text message control.
      Patients aged 50-74 years, who are registered at a Family Practice and Counselling Network
      (FPCN) clinic and are overdue for colorectal cancer screening will be recruited. The primary
      outcome is the rate of FIT kits being returned at 12 weeks.
    

Detailed description: 
      It is estimated that colorectal cancer (CRC) screening can reduce the risk of dying from
      bowel cancer by approximately 15%. Yet despite this, the national participation rate is only
      approximately 62.9%, highlighting that the national target of 70.5% set out in the Healthy
      People 2020 Objectives remains well out of reach. The US Preventative Task Force (USPSTF)
      recommends colorectal screening for adults aged 50-75 years through either annual fecal
      occult blood testing (FOBT), flexible sigmoidoscopy every 5 years or colonoscopy every 10
      years. However, many service providers rely on the opportunistic offer of screening at
      existing health touch-points. This requires the patient to see their healthcare provider,
      usually for a different clinical reason, the provider to recognize that the patient is
      overdue for CRC screening and the provider to recommend and book the patient for CRC
      screening. This process identifies a number of barriers encountered at the system, provider
      and patient level, to completing a screening test regularly. Furthermore, much evidence
      indicates that public participation in colorectal screening is heavily influences by
      socioeconomic factors. Lower participation rates are seen in individuals without health
      insurance, without a medical home, who are more deprived and from ethnic minority groups.
      These individuals are more likely to present with later stage disease and experience poorer
      outcomes. Fecal immunochemistry testing (FIT) is a stool sample based test kit that uses
      antibodies to detect the human haemoglobin protein in the stool sample and can be completed
      in the privacy of the home. Research has showed that mailed home test kits such as FOBT or
      FIT kits can improve CRC participation by reducing the effort required to see a provider in
      order to arrange CRC screening. Evidence has also shown that text message reminders can
      improve participation in cancer screening. Furthermore, the message content of text messages
      can differentially change behavior, for example reducing the 'did not attend rate' in
      hospital outpatient appointments but also in the context of participation in cervical cancer
      screening. Therefore this trial will test a multimodal outreach approach, which uses serial
      SMS reminders with different word contents and mailed FIT kits on the participation rates of
      CRC screening.
    

Intervention name(s): Serial text messages and mailed FIT kit
Intervention type(s): Behavioral
Intervention description(s): Pre-alert SMS offering Opt-out of mailed FIT kit
Mailed home FIT kit
SMS A - Reciprocity message
SMS B - Offer for second FIT kit if lost/did not receive
Plus SMS A + C if second mailed FIT is requested.
SMS C - Salience message
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Screening
Keywords: Colon cancer; Bowel cancer; Cancer screening; text message; Fecal immunochemistry test (FIT); opt-out; behavioral intervention