A qualitative study of patient preferences for prompts and reminders for a direct-mail fecal testing program

Abstract

Programs that directly mail fecal immunochemical tests (FIT) to patients can increase colorectal cancer (CRC) screening, especially in low-income and Latino populations. Few studies have explored patient reactions to prompts or reminders that accompany such programs. As part of the Participatory Research to Advance Colon Cancer Prevention pilot study, which tested prompts and reminders to a direct-mail FIT program in a large, urban health center, we conducted telephone interviews among English- and Spanish-speaking participants who were assigned to receive a series of text message prompts, automated phone call reminders, and/or live phone call reminders. We analyzed interviews using a qualitative content analysis approach. We interviewed 41 participants, including 25 responders (61%) and 16 nonresponders (39%) to the direct-mail program. Participants appreciated program ease and convenience. Few participants recalled receiving prompts or automated/live reminders; nevertheless, the vast majority (95%, n = 39) thought reminders were acceptable and helpful and suggested that 2–3 reminders delivered starting 1 week after the mailed FIT would optimally encourage completion. Prompts and reminders used with mailed-FIT programs are accepted by patients, and my help boost response rates.

Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff

“…Interviews were conducted by an experienced qualitative researcher (J.L.S. ), 17,19,33,34 lasted approximately 60 minutes, and were audio recorded and transcribed.…”

“…[13][14][15][16] However, return rates vary widely, 7,17 owing in part to patient, intervention, and clinic characteristics. 7,8,[18][19][20] Although mailed FIT programs comprise a population outreach strategy, return rates are greater among patients who attend a clinic visit in the same year, 21,22 underscoring the importance of clinic support. 23 Resources exist to help implement mailed FIT programs, 18,24 but research is needed to identify mutable clinic-level factors that optimize these programs.…”

Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot

“…Our findings also suggest opportunities for tailoring mailed FIT elements at the patient level to reach those at risk for nonresponse and to conserve resources for those who are likely to respond with minimal reminders or prompts. For example, patients screened in the past are more likely to respond to a mailed FIT program and may, therefore, not need supplemental outreach 63,64 . In contrast, certain population groups may be less likely to respond (eg, younger patients, women, Medicaid‐insured, at higher levels of risk, and Latino patients) and strategies could be tailored to support targeted outreach to these populations.…”

“…For example, patients screened in the past are more likely to respond to a mailed FIT program and may, therefore, not need supplemental outreach. 63,64 In contrast, certain population groups may be less likely to respond (eg, younger patients, women, Medicaid-insured, at higher levels of risk, and Latino patients) and strategies could be tailored to support targeted outreach to these populations. These may include routine mailed FIT as well as strategies for bundling FIT with other preventive strategies (at home testing for diabetes, HPV, and blood pressure) (Coury J and Davis MM, In preparation).…”

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation

“…A yearly FIT is a recommended screening method for asymptomatic adults aged ≥45 years who are at an average risk of CRC [ 3 ]. Findings from a Participatory Research to Advance Colon Cancer Prevention pilot study showed that patients with no prior history of CRC screening are more likely to respond to more intensive communication modalities [ 4 ] and that some unscreened populations may require multiple outreach and education modalities and touchpoints [ 5 ].…”