Abstract 594: Strategies to improve repeat CRC screening in rural community clinics using the fecal immunochemical test (FIT)
Authors: Arnold Connie L. , Davis Terry C. , Morris James , Rademaker Alfred , Mills Glenn 
Published: August 2018

Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas.

Objectives: To assess the effectiveness of two health literacy informed telephone follow-up strategies to improve annual repeat screening with Fecal Immunochemical Test (FIT) in rural community clinics.

Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 1% to 3%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th grade level), the FIT kit with pre-addressed envelope, simplified instructions (3rd grade level) and a demonstration of how to use it, At four weeks patients who had not returned their kit receive either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete and mail the FIT. During years 2 and 3, FIT kits were mailed to patients along with previous literacy and culturally appropriate education. Follow-up call procedures previously used at weeks 4 and 8 were followed.

Results: 620 patients not up-to-date with screening were enrolled; 66% were African American, 55% women; 40% had limited literacy.

Screening results:

1st Year Screening: 620 patients enrolled - (6 withdrew before completing test)

AC Arm (n=308)

213 (69%) completed kits [23 (7%) positive]

124 (40%) people needed at least one follow-up call [29 (24%) returned FIT after call]

PC Arm (n=306)

205 (67%) completed kits [21 (7%) positive]

127 (41%) people needed at least one follow-up call [26 (20%) returned FIT after call]

2nd Year Screening: 568 Second kits mailed (4 withdrew and no previous positives included)

AC Arm (n=285)

111 (40%) completed kits [9 (8%) positive]

212 (74%) people needed at least one follow-up call [40 (19%) returned FIT after call]PC Arm (n=283)

104 (37%) completed kits [8 (8%) positive]

209 (74%) people needed at least one follow-up call [31 (15%) returned FIT after call]

Discussion: Simplified instructions accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. The less costly and time consuming automated call was equally effective as a personal call.

Citation Format: Connie L. Arnold, Terry C. Davis, James Morris, Alfred Rademaker, Glenn Mills. Strategies to improve repeat CRC screening in rural community clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 594.