Association of Interactive Reminders and Automated Messages With Persistent Adherence to Colorectal Cancer Screening
Authors: Martin C. S. Wong, Jessica Y. L. Ching, Thomas Y. T. Lam, Simpson K. C. Ng, John C. T. Wong, Justin C. Y. Wu, Francis K. L. Chan
Journal: JAMA Oncology (2017)

The US Preventive Services Task Force recommends annual fecal immunochemical test (FIT) as one of the colorectal cancer (CRC) screening tests. 1 Adherence to yearly FIT is crucial to programmatic success. 2 However, longitudinal adherence is low and strategies to improve persistent adherence are needed. 3 We evaluated the effectiveness of interactive telephone calls vs automated short message service (SMS) on improving adherence to FIT screening compared with usual care.Methods | We conducted a prospective randomized parallel group study, with the setting previously described. 4 The trial was registered on Clinicaltrials.gov(NCT02815436).Asymptomatic patients with negative FIT results in their first screening round from April to September 2015 due for annual screening in 2016 were eligible.Patients who could not understand telephone or SMS, or did not have mobile phones were excluded.Participants were randomized by a computergenerated sequence with an allocation ratio of 1:1:1.In the control group, participants were told in 2015 that they should visit the screening center for annual FIT pickup at the same calendar month of 2016.In the SMS group, subjects received a 1-way SMS, highlighting importance of CRC screening, and notifying date and location of FIT pickup on their mobile.In the telephone group, participants received a call from a trained health care physician with the same message as the SMS, but an interactive conversation was permitted.The interventions were delivered 1 month before the expected date of participant return for second round of screening.The Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee approved the study and participant consent was waived because the interventions were an extension of the screening services.The trial protocol is provided in the Supplement.Outcomes were rate of FIT pickup within 1 month of a patient's anticipated return, and rate of FIT return within 2 months of anticipated return.Six hundred patients provide 80% power (at 5% α level) for detecting an 11% increase in FIT return rate in the intervention groups compared with control, which was assumed to have a FIT return rate of 70%. 5 Associations between study groups and outcomes were examined by backward stepwise, binary logistic regression.Subgroup analysis for sex, marital status, household income, and educational level were performed, because these factors were previously found to be associated with screening adherence. 6 Figure. Consort Flow Diagram630 Assessed for eligibility 1 Excluded No mobile phone 629 Randomized 212 Allocated to SMS messages intervention 78 Excluded Did not pick up FIT on time at follow-up 45 Excluded Did not pick up FIT on time at follow-up 21 Excluded Did not pick up FIT on time at follow-up 2 Excluded 1 Received colonoscopy in other sectors before second round of FIT 1 Change in bowel habits before second round of FIT 3 Excluded Received colonoscopy in other sectors before second round of FIT 3 Excluded Received colonoscopy in other sectors before second round of FIT 207 Allocated to interactive telephone messages intervention 210 Allocated to control group 207 Analyzed 209 Analyzed 205 Analyzed 3 Excluded Already received cancer screening or not expected to return for follow-up 3 Excluded Already received cancer screening or not expected to return for follow-up 2 Excluded Already received cancer screening or not expected to return for follow-up FIT indicates fecal immunochemical test.