Using Behavioral Science to Improve Colorectal Cancer Screening Rates With Mailed FIT Kits

Study Overview
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Brief Summary
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As a part of UCLA Health's continued goal of improving patient care the investigators are updating our mailing campaign for our FIT Kit colorectal cancer screening that the investigators administer 2 times per year to include an automated phone call reminder to patients who are overdue for average-risk colorectal cancer screening and enrolled in a mailed FIT program. This will help the investigators evaluate if automated phone calls are effective at improving compliance with CRC screening, in addition to mailed FIT and embedded electronic health record (EHR) portal messages to patients.

Detailed Description
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UCLA Health has a biannual mailed FIT program designed to capture patients overdue for CRC screening who are average-risk for CRC. With every campaign, the investigators attempt to improve the return rates for patients receiving the FIT Kits. For the current campaign, all patients enrolled will receive usual care and the investigators are delivering an automated phone call to half the eligible patients reminding them to return their FIT kits and prompting them to request a new kit if needed. The investigators will investigate if this intervention increases the number of patients who complete the mailed Fit Kit or any type of CRC screening over a 6-month follow up period. This quality improvement project will help the investigators improve the processes of care for the patients, and community. If this phone call is successful the investigators will likely expand it to the entire population in future FIT Kit mailer campaigns. However, if it is not effective this will help the investigators minimize the number of calls/interventions the investigators send to patients and will hopefully allow for more useful outreach to patients in the future.

Official Title
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Impact of Automated Telephone Outreach on Colorectal Cancer Screening Uptake Among Patients Who Receive Mailed Fecal Immunochemical Tests (FIT)

Conditions
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Colorectal Cancer Screening

Intervention / Treatment
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* Behavioral: Delayed automated phone call


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Overdue for average-risk colorectal cancer screening Active primary care provider at UCLA seen within last 3 years Exclusion Criteria: Inactive mychart status at time of enrollment Died within follow-up period Received FIT kit in prior 6 months

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description:  2500 patients who are overdue for average-risk CRC screening and are enrolled in UCLA Health biannual mailed FIT program will be randomized to either control (mailed FIT kit + standard messaging) or intervention (mailed FIT Kit + standard messaging + delayed automated phone reminder)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>This group will receive standard FIT mailer protocol (includes mailed FIT kit plus standardized messaging via EHR portal) | |
| Experimental: Intervention<br>This group will receive standard FIT mailer protocol (as above) PLUS delayed automated phone reminder | Behavioral: Delayed automated phone call<br>* Cipher provides automated phone calls to patients; in this case the script for Cipher was modified to provide patients a reminder to return FIT kits, allow patients to request a new kit in case they need a replacement, and to allow patients to provide information if they already completed CRC screening<br>* Other names: Cipher phone reminder;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall colorectal cancer screening uptake (any modality) | Rate of completion of CRC screening by any of the following: FIT, colonoscopy, CT colonography, sigmoidoscopy or FIT-DNA within study period. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Colorectal cancer screening uptake by modality | Rate of completion of CRC screening by modality type | 6 months |