Evaluating Outreach Methods for Multi-Target Stool DNA Test for Colorectal Cancer Screening Among an Employer Population

Abstract

Introduction/Objectives: Despite compelling evidence of clinical and economic benefits, adherence to colorectal cancer (CRC) screening remains low. Increasing public awareness through various outreach methods may improve screening uptake. The objective of this study was to evaluate the uptake of non-invasive multi-target stool DNA (mt-sDNA) by different outreach methods in an average-risk employer population. Methods: This retrospective observational study included CRC screening-eligible individuals aged ≥50 years insured by the Metropolitan Nashville Public Schools (MNPS) employee healthcare plan. The study intervention arms included population-based outreach and office visit-based interaction. The mt-sDNA completion rate (proportion of individuals who return the mt-sDNA kit after consenting to have it shipped to their home), proportion of patients who performed follow-up colonoscopy after a positive test, and time to follow-up colonoscopy were assessed. Results: A total of 167 mt-sDNA kits were shipped to eligible participants (aged 50-64 years) in the population-based outreach arm. In the office visit-based interaction arm, a total of 132 mt-sDNA kits were shipped to eligible participants (aged ≥50 years). The mt-sDNA completion rate was significantly higher for office visit-based interaction as compared to population-based outreach (76.8% vs 53.5%; P < .001) among those aged 50 to 64 years. While all patients aged 50 to 64 years with a positive mt-sDNA result received a follow-up colonoscopy in both arms, the median time to follow-up colonoscopy was shorter among the population-based outreach (55 vs 136 days; P < .05). Conclusions: Office visit-based interaction was associated with a higher mt-sDNA completion rate as compared to the population-based outreach among average-risk, CRC screening-eligible individuals aged 50 to 64 years old.

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes

“…The median duration for both mt-sDNA order to completion and positive result to follow-up colonoscopy were consistent with previously reported figures [13,17,21]. Of all patients with a positive mt-sDNA, 70.3% underwent follow-up colonoscopy within the study time period.…”

“…Another well-documented issue is compliance with mt-sDNA testing [9,13,17], including both completion of ordered tests and definitive follow-up colonoscopy in the event of a positive test. Our results showed a 59.5% completion rate of all ordered mt-sDNA tests, a figure slightly lower than reported rates [3,17,21].…”

“…Another well-documented issue is compliance with mt-sDNA testing [9,13,17], including both completion of ordered tests and definitive follow-up colonoscopy in the event of a positive test. Our results showed a 59.5% completion rate of all ordered mt-sDNA tests, a figure slightly lower than reported rates [3,17,21]. The proportions of positive and negative tests did not differ between groups, in contrast with a recent study that estimated a three-fold high risk of positive results for off-label patients [21].…”

“…Lack of follow-up and subsequent order expiration was the most common reason for non-completion in our population. Both outreach and "inreach" methods have been discussed in previous studies with improvement in mt-sDNA adherence rates [11,17,19], which argues for a more robust and widespread adoption of such practices. Patient refusal was the second most common reason for the non-completion of tests in our population, likely representing a multifactorial issue for patients and ordering providers.…”

“…Outreach initiatives, such as virtual chart reminders, office calls, and office-based education (referred to as "inreach"), have shown promising results in enhancing adherence [17][18][19][20]. However, there is limited research investigating the reasons for incomplete testing and other factors predicting completion, underscoring the need for further investigation.…”