Randomized Trial of a Home-Based Intervention to Improve Colon Cancer Screening Rates

Charlton ME, Mengeling M, Halfdanarson T, Kaboli PJ. Randomized Trial of a Home-Based Intervention to Improve Colon Cancer Screening Rates. Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD.

Related HSR&D Project(s)

• IIR 08-067 – Organizational Factors and Inpatient Medical Care

Objectives: Distance from VAMCs can be a barrier to colorectal cancer (CRC) screening, with 42% of Veterans living > 90 miles away. Fecal immunochemical tests (FIT) require only one sample and were recently approved for VA use. Our objective was to determine if FIT kits mailed to Veterans would result in higher screening rates in asymptomatic, average-risk Veterans than mailing educational materials alone. Methods: This randomized trial included Iowa City VA users ages 50 to 64 (65% rural) who were overdue for screening, > = 2 primary care visits in past 13 months, at average CRC risk, and asymptomatic. Exclusions included history of irritable bowel, polyps, personal/family CRC, rectal bleeding, and change in bowel habits. 499 controls were mailed CRC educational materials and a survey of CRC screening outside VA; 500 intervention subjects were mailed the same materials, plus FIT kits. Results: At six months follow-up, 28 control patients received CRC screening compared with 100 patients in the FIT intervention group (5.6% vs. 20%; p < .0001); 68 (13.6%) intervention patients returned the FIT kit, of which 7 were ineligible due to current symptoms or medical history. Of the remaining, 6 (9.8%) had positive FIT results and were contacted for follow-up. Fifty-six FIT and 108 control group subjects returned the survey (response rate 16.4%). Of those, 67 (41%) were ineligible due to current symptoms or history that require more active CRC surveillance. Of those eligible, 31% reported a colonoscopy outside VA in the past 10 years. When limited to the 62 subjects not at high risk and not screened outside VA, the FIT return rate was 98%. Implications: This low-intensity intervention resulted in a significantly higher screening rate than controls, and for those eligible, almost 100% received screening. Of note, survey findings suggest almost one-third of VA users who appear to be overdue for screening are screened outside VA. Impacts: Overall FIT return rate was low indicating that a mail-only program may have limited success. Future studies should use other methods to eliminate those already screened outside VA. Veterans overdue for screening appear to be open to taking FIT kits mailed to their homes.