Study participant screening use and preference increased. Age and attitudes predicted outcomes. Randomized trials are needed to determine intervention impact at the population level.

Background This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer (CRC) screening adherence and screening decision stage (SDS). Methods Primary care patients (n=945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n=312), Standard Intervention (SI) Group (n=316), or usual care Control Group (n=317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months. Results The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (p=0.001 and p=0.001, respectively), but the two intervention groups did not differ significantly (p=0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (p=0.001 and p=0.001, respectively), and the intervention group difference approached significance (p=0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options. Conclusions Both interventions had significant, positive effects on outcomes compared to usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS. Impact Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.

BACKGROUND. Colorectal cancer (CRC) screening is cost‐effective but underused. The objective of this study was to determine the cost‐effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia. METHODS. The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention. Percent increase in screening was adjusted for baseline differences in the study groups. Each intervention arm received a targeted screening invitation letter, stool blood test (SBT) cards, informational booklet, and reminder letter. Tailored interventions incrementally added tailored messages and reminder telephone calls. RESULTS. Program costs of the targeted intervention were $42 per participant. Additional costs of adding tailored print materials and of delivering a reminder telephone call were $150 and $200 per participant, respectively. The cost per additional individual screened was $319 when comparing the no intervention group with the targeted intervention group. CONCLUSIONS. The targeted intervention was more effective and less costly than the tailored intervention. Although tailoring plus reminder telephone call was the most effective strategy, it was very costly per additional individual screened. Mailed SBT cards significantly boosted CRC screening use. However, going beyond the targeted intervention to include tailoring or tailoring plus reminder calls in the manner used in this study did not appear to be an economically attractive strategy. Cancer 2008. © 2007 American Cancer Society.