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Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening: Rate of Return in Year 2

Charlton ME, Mengeling M, Torner J, Makki N, Klutts S, Malhotra A, Levy B, Halfdanarson T, Kaboli PJ. Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening: Rate of Return in Year 2. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.




Abstract:

Research Objective: Distance from healthcare facilities can be a barrier to colorectal cancer newer (CRC) screening, especially for colonoscopy. A newer alternative is an improved at-home stool-based test requiring only one sample, the fecal immunochemical test (FIT). A cohort of veterans overdue for CRC screening was identified in 2011-12 in a predominantly rural Veterans Affairs (VA) Health Care System catchment area, and an intervention involving mailing FITs to patients' homes was tested. Those who had negative FIT results continued to Phase 2. The objective in this phase was to determine the proportion of veterans who would complete a second FIT mailed to them one year after completing an initial FIT. Study Design: One year post-intervention, subjects received a recruitment mailing and a telephone call to assess eligibility and interest in participating in Phase 2, which included a second FIT and a brief survey. Population Studied: Phase 1 included veterans ages 51-64 who were regular users of VA healthcare and were asymptomatic, at average risk, and overdue for CRC screening. Those over 65 were excluded due to their likelihood of using non-VA services covered by Medicare. Phase 2 included those who completed an initial FIT and received a negative result. Principal Findings: Of 192 veterans who took the FIT one year prior, 32 were ineligible for follow up testing (23 due to recent symptoms or medical history, 7 received a recent colonoscopy, 1 deceased, 1 moved away). Of the remaining 160 veterans, 126 (79%) agreed to take the survey and complete the FIT, 20 (13%) refused to continue participation, 3 (2%) had a scheduled colonoscopy and 11 (7%) could not be contacted. There were no significant demographic differences between participants and those who refused. Both groups were 90% male with an average age of 62. A higher proportion of participants were rural (58%) compared to those who refused (40%), but difference was non-significant. Among 126 survey respondents, 90% reported the FIT was easy, convenient, and it was important to have the FIT mailed to them rather than have to pick it up at a clinic/facility. Ninety-eight percent indicated they would be extremely/very likely to complete the FIT each year if mailed to them annually. Thus far, 78% of participants have completed and returned FITs; 93% were negative and 7% were positive and are scheduled for clinical follow-up. Conclusions: Among veterans who were overdue for CRC screening and agreed to take a FIT mailed to their home, an overwhelmingmajority was amenable to taking it again one year later and reported a high level of satisfaction with this method of screening. Implications for Policy, Delivery, or Practice: The FIT presents a reasonable alternative in a population who were initially non-adherent to colorectal cancer screening guidelines. Annual FIT mailing programs may have the potential to increase CRC screening rates, particularly among those who face distance barriers to health care services. Further, these programs can stratify average risk patients to FIT testing, thus allowing those at high risk to have greater access to colonoscopy services.





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