Developing Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program in a Latino-Based Community Health Center

Abstract

Introduction: Colon cancer is the second leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. One factor thought to contribute to the low screening rate is the difficulty Latinos encounter in understanding health information, and therefore in taking appropriate health action. Therefore, we used Boot Camp Translation (BCT), a patient engagement approach, to engage Latino stakeholders (ie, patients, clinic staff) in refining the messages and format of colon cancer screening reminders for a clinic-based direct mail fecal immunochemical testing (FIT) program.Methods: Patient participants were Latino, ages 50 to 75 years, able to speak English or Spanish, and willing to participate in the in-person kickoff meeting and follow-up phone calls over a 3-month period. We held separate BCT sessions for English-and Spanish-speaking participants. As part of the in-person meetings, a bilingual colon cancer expert presented on colon health and screening messages and BCT facilitators led interactive sessions where participants reviewed materials and reminder messages in various modalities (eg, letter, text). Participants considered what information about colon cancer screening was important, the best methods to share these messages, and the timing and frequency with which these messages should be delivered to patients to encourage FIT completion. We used follow-up phone calls to iteratively refine materials developed based on key learnings from the in-person meeting.Results: Twenty-five adults participated in the in-person sessions (English [n ‫؍‬ 12]; Spanish [n ‫؍‬ 13]). Patient participants were primarily enrolled in Medicaid/uninsured (76%) and had annual household incomes less than $20,000 (67%). Key themes distilled from the sessions included increasing awareness that screening can prevent colon cancer, stressing the urgency of screening, emphasizing the motivating influence of family, and using personalized messages from the practice such as 'I' or 'we' statements in letters or automated phone call reminders delivered by humans. Participants in both sessions noted the importance of receiving an automated or live alert before a FIT kit is mailed and a reminder within 2 weeks of FIT kit mailing.Discussion: Using BCT, we successfully incorporated participant feedback to adapt culturally relevant health messages to promote FIT testing among Latino patients served by community clinics. Materials will be tested in the larger Participatory Research to Advance Colon Cancer Prevention (PROMPT) trial. (J Am Board Fam Med 2019;32:307-317.)

Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Findings from the PROMPT Study

“…Our mailed FIT outreach intervention was designed with input from patients and clinicians, using boot camp translation (see companion article, Thompson et al JABFM 18 -0026). 17 We found that delivering live telephone reminders after sending a mailed FIT, alone or in combination with text message prompts and automated telephone call reminders, can increase response rates by 6 to 9 percentage points compared with text message prompts and automated calls without a live phone component in a large, urban, primarily Latinoserving community health center. Overall, FIT completion rates were higher in patients whose preferred language was Spanish (vs English), who had 1 or more clinic visits in the past year (vs none), and who had completed a prior FIT (vs never completed an FIT).…”

“…The study's boot camp translation methods have been reported previously (see companion article Thompson et al JABFM 18 -0026). 15,17 Briefly, we recruited 25 patients and 4 clinic staff to participate 2 parallel boot camp translation programs, 1 in English and 1 in Spanish. Each program included a 6-hour in-person session that consisted of an expert presentation and interactive large-and small-group activities aimed at developing initial drafts of outreach materials, and 3 30-to 45-minute group conference calls facilitated by a member of the project team.…”

Randomized Controlled Trial of Advance Notification Phone Calls vs Text Messages Prior to Mailed Fecal Test Outreach

“…We obtained process data from the text message vendor and from the clinic staff who completed the live calls, which allowed us to discern which patients received the intended notification and to compare our findings using both intention-to-treat and per-protocol analyses. We relied on robust formative research to incorporate patient preferences (from both Englishand Spanish-speaking patients) into the design of our program, 21 which enhanced the relevance of our findings for both patients and clinic staff.…”

Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities

“…70,71 Such stakeholder approaches have been successful in designing tailored screening interventions for sporadic CRC in Hispanic populations and hold promise for improving equity of hereditary cancer prevention. 109,110 In conclusion, to narrow health care inequities in genomic medicine, it is critical to reduce barriers to cancer riskreducing interventions, especially in underserved populations. Our review identified care system and clinician factors, systemic and structural barriers, and some patient-level factors that affect uptake and adherence to risk-reducing interventions among those with hereditary cancer syndromes.…”