Improving Fecal Occult Blood Testing Compliance Using a Mailed Educational Reminder

Abstract

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low. OBJECTIVE:To determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance. DESIGN:Blinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California.PATIENTS: Seven hundred and seventy-five consecutive patients ≥50 years of age referred by their primary care physicians for FOBT. INTERVENTION:Patients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only. MEASUREMENTS:The primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis.RESULTS: At 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P<0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48-2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29-2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13-0.50).CONCLUSION: A simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.

1035 Cost-Effectiveness of a Mailed Educational Reminder to Increase Colorectal Cancer Screening

“…A simple mailed educational reminder, mailed 10 days after patients picked up their FOBT cards from the laboratory, significantly increased FOBT card return rate by 16.2% compared to the control group (64.4% vs. 48.4%, P < 0.001) [12]. The total cost of our intervention was $962, which came out to be $2.49 per individual in our study population.…”

“…Detailed descriptions of the design, methods, primary, and secondary outcomes of the randomized controlled trial on using a mailed educational reminder to increase FOBT card return rates have been published [12]. Here we provide a brief summary of the clinical trial and analytic methods below…”

“…Recently, we reported that a mailed educational reminder increased FOBT card return rate for CRC screening by 16.2% (P < 0.001) at a large Veteran Affairs (VA) medical center [12]. However, it is not known if our intervention was cost-effective, particularly in the context of other similar cancer screening promotion programs.…”

“…The baseline demographic and clinical characteristics were well matched in both the control and intervention groups [12]. The mean age of our study participants was 63.1 years (SD = 9.6).…”

Blood-Based Screening for Colon Cancer

“…Even among existing noninvasive tests for colon cancer, adherence is low: for annual FOBT, on average only half of participants return stool cards appropriately. 4 Evidence suggests that some patients who are reluctant to undergo screening would be receptive to a blood test. In one survey, 97% (106/109) who refused colonoscopy accepted a noninvasive screening test, and 83% (90/109) of those preferred a blood test.…”