Advanced Notification Calls Prior to Mailed Fecal Immunochemical Test in Previously Screened Patients: a Randomized Controlled Trial

Abstract

BACKGROUND: Phone calls as part of multimodal fecal immunochemical test (FIT) outreach are effective but resource-intensive. Previous studies of advanced notification calls before FIT mailing have not differentiated patients' prior screening status. OBJECTIVE: To determine the effectiveness of a phone call preceding mailing of a FIT kit on test completion rate for patients who have completed a prior FIT. DESIGN: Randomized controlled trial nested within a larger study. All patients were assigned to receive organized mailed FIT outreach in the larger study. PARTICIPANTS: Patients in a safety-net health setting ages 50-75 years old with a previously negative FIT. INTERVENTIONS: Patients were assigned to either receive an advanced notification phone call or no phone call preceding a mailed FIT kit. Both groups received an informational postcard prior to the mailed FIT. MAIN MEASURES: The primary outcome was FIT completion rate at 1 year. The secondary outcomes were FIT completion rates at 60, 90, and 180 days, rates stratified by demographic subgroups, and rates according to outcome of the phone call. KEY RESULTS: A total of 1645 patients were assigned to advanced notification calls and 1595 were assigned to no call preceding the FIT mailing. Although FIT completion rate was higher at day 60 (55.5% vs. 50.8%, p < 0.01), an advanced notification call did not significantly improve FIT completion at 1 year (70.9% vs. 69.9%, p = 0.52). Of the patients assigned to receive an advanced notification call, 90.5% were spoken with or left a voicemail; patients who were spoken with were more likely to complete a FIT at 1 year compared with patients who were only left a voicemail or could not be left a voicemail (79.9% vs. 69.2% vs. 49.6%, p < 0.01).CONCLUSIONS: Advanced notification phone calls prior to FIT mailing did not improve rates at 1 year for patients with a previously negative FIT.

The implementation and mechanisms of advance notification for cancer screening: A scoping review

“…The key characteristics of the 32 included articles are summarised in Table 1 9,11–13,15,18,24,29,30,33–55 . Of these, the majority originated in the United States of America (41%), with others from the United Kingdom (25%), Australia (13%), Denmark (3%), Italy (3%), Latvia (3%), the Netherlands (3%), New Zealand (3%), Spain (3%), and Sweden (3%).…”

“…The invitation process was described, including when to expect the screening offer, what to do upon its arrival, and in the case of one mailed notification, how to distinguish the screening invitation from other mail, 18 presumably to prevent misplacement. Details of what to expect during the screening procedure, for example, a description of how to complete the bowel cancer screening kit 24,51,54 or how a cervical screening test is performed, 42 as well as what to expect after the test, such as the outcomes of a positive test result, 38,50,54 were also sometimes provided. Advance notifications commonly provided facts about where to access more information about screening, usually providing helplines, websites, and other printed materials for reference, or in the case of phone calls, the opportunity to seek answers directly from the caller 34,50,51 …”

Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review

“…Ten studies were published between 2021 and 2022; 14 studies investigated interventions in the United States; and the most common study designs used were randomized controlled trials and controlled clinical trials (n = 14). Most studies (n = 17) described the included populations as having no or limited access to the healthcare system (e.g., immigrant populations [ 52 ], uninsured groups [ 38 – 40 ], and publicly funded safety-net health system in United States [ 42 , 43 ]). Only five studies stratified findings for the population group with no regular healthcare providers.…”

“…Most studies on FIT effectiveness had FIT kits returned by mail (n = 12). In the quality appraisal, 16 studies scored as weak [ 31 , 33 , 37 , 38 , 40 – 42 , 44 – 49 , 51 , 52 , 54 ]; eight scored as ‘moderate’ [ 30 , 32 , 34 , 36 , 39 , 43 , 50 , 53 ]; and one [ 35 ] as ‘strong’. Overall, the quality of evidence was weak due to parameters related to selection bias, study design, and reporting of follow-up rates.…”

Effective Strategies for Fecal Immunochemical Tests (FIT) Programs to Improve Colorectal Cancer Screening Uptake Among Populations with Limited Access to the Healthcare System: A Rapid Systematic Review

“…in the usual care group) [42]. Other study that included only population with a history of FIT completion found modest differences in FIT completion between the group receiving noti cation phone calls and the group with no phone calls [43]. This suggests that groups with prior history of FIT may require less reminder methods for the subsequent FIT completion [43].…”