Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial

Azulay, Revital; Valinsky, Liora; Sikron, Fabienne; Magnezi, Racheli

doi:10.2196/11114

Cited by 16 publications

(25 citation statements)

References 50 publications

(39 reference statements)

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“…It is essential to ensure that patients who are provided with a FIT understand the purpose of the test and what they need to do if the result is positive in advance. Reminders after completion of the test have differing degrees of effectiveness, although we found, in a previous study that telephone text reminders can increase follow-up in our population [9]. If patients are aware of the implications of non-adherence, reminders may prove to be more effective.…”

Section: Recommendationsmentioning

confidence: 51%

“…Recommended strategies for early detection for population screening are either fecal occult blood testing (FOBT) yearly or colonoscopy every 10 years from the age of 50 to 74 years [2]. National CRC screening programs are available in many countries (Canada, Britain, France, Italy, Australia, Israel, Sweden and Denmark), and participation rates vary between 30 and 60%, although specific interventions have led to participation rates of up to 80% [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Barriers to completing colonoscopy after a positive fecal occult blood test

Azulay

Valinsky

Sikron

et al. 2021

Isr J Health Policy Res

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Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.

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Section: Recommendationsmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Barriers to completing colonoscopy after a positive fecal occult blood test

Azulay

Valinsky

Sikron

et al. 2021

Isr J Health Policy Res

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“…36 Regarding systemrelated factors, there is evidence that systemic interventions can have moderate effects on improving uptake and adherence to FOBT testing, and can lead to increased performance of follow-up colonoscopy. 37 Furthermore, patient-level interventions which have been found to be successful in reducing waiting times after FOBT include cellphone reminders 36 and patient navigators, while reporting performance or sending reminders are effective provider-level interventions. 38 Our finding, noted by others, that increased contact with the healthcare system, as measured by the frequency of physician visits, 22,39 was related to longitudinal adherence to screening reinforces the role of health professionals in enhancing screening uptake and consistency.…”

Section: Discussionmentioning

confidence: 99%

Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records

et al. 2020

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Objectives To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel. Setting Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program. Methods Screening uptake for the eligible population (aged 50–74) was recorded 2003–2018 using aggregate data. For a subcohort (2008–2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models. Results The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60–74 and >six-fold for 50–59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2–113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence. Conclusions Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.

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“…As stated above, this study stemmed from a previous study 31 that examined the effect of a text message on adherence to follow-up. Therefore, participants in the current study had been randomized into an intervention group, who received an SMS alert regarding their test results, and a control group, who did not.…”

Section: Methodsmentioning

confidence: 99%

“…The rate of follow-up colonoscopy after a positive FIT in Meuhedet was 41%. In order to improve follow-up rates, we conducted a study 31 in 2016 assessing the usefulness of sending a short message service (SMS) regarding colonoscopy follow-up after a positive FIT. We found that 17% of patients who had completed an FOBT did not remember having the test and were not aware of the test results.…”

Section: Introductionmentioning

confidence: 99%

CRC Screening Results: Patient Comprehension and Follow-up

et al. 2019

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Background:Fecal occult blood tests are recommended for colorectal cancer screening, but are only effective if colonoscopy follows positive results. Patients with positive results often do not complete follow-up. This study examined the association between patient comprehension and adherence to colonoscopy after positive FIT (Fecal Immunochemical Test).Methods:Five hundred twenty-two patients completed a telephone questionnaire regarding the FIT and its implications 120 days after a positive result. Patients were asked whether they had the test, received the results, and required follow-up. These questions were used to identify the degree to which patients understood medical information. A participant who answered “no” to any question was defined as having “low comprehension” regarding the FIT, and participants who answered “yes” to all 3 questions, as having “high comprehension”.Results:Comprehension and colonoscopy adherence were significantly associated. Adherence to colonoscopy was significantly higher among participants with high comprehension, after adjusting for gender, age, education, ethnicity, and socio-economic status.Conclusions:This study demonstrates a link between health comprehension and patient follow-up after positive FIT and contributes to understanding the implications of health comprehension in terms of health promotion. We recommend patients undergoing screening tests receive clear explanations regarding need for follow-up of positive results thus reducing health disparities associated with health comprehension.

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Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial

Cited by 16 publications

References 50 publications

Barriers to completing colonoscopy after a positive fecal occult blood test

Barriers to completing colonoscopy after a positive fecal occult blood test

Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records

CRC Screening Results: Patient Comprehension and Follow-up

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