- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02651974
Evidence Based Colorectal Cancer Screening for the Uninsured - Sub-study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In the previously initiated, ongoing clinical study (# NCT01946282) investigators are testing a systematic colon cancer screening outreach strategy for increasing screening completion among uninsured patients, not up-to-date with screening. This is a Sub-study to #NCT01946282 (IRB # 082012-086).
Sub-study description:
The goal of the sub-study is to identify strategies that may further increase rates of 1) initial participation in colorectal cancer screening, and 2) follow up of abnormal colorectal cancer screening tests with colonoscopy.
At the time of the sub-study, all patients randomly assigned to receive gift card incentives have been enrolled. At this time only standard, non-incentive invitations continue to be mailed to eligible patients.
The sub-study involves 2 parts:
Part 1: Participants scheduled to receive mailed fecal immunochemical test (FIT) outreach for the first time late in the 2nd year of the study will be randomly assigned to receive one of three invitation letters, which vary slightly from one another.
For the sub-study, the standard invitation letter will be replaced with one of the three sub-study letters. All new participants will receive one of the 3 letters during 2 predetermined rounds of invitations (involving n=2,124 individuals). There will be 3 conditions for the sub-study letters and individuals will be randomly assigned 1:1:1 to each condition. The 3 conditions are as follows:
i) Condition 1 - control letter will be similar to the previous study letters with some slight wording and grammatical improvements, ii) Condition 2 - cost letter will be the control letter plus the addition of one sentence informing recipients of the average value of the FIT procedure and; iii) Condition 3 - cost/future letter will include the average value of FIT and a sentence assuring patients that should a follow-up test be requested, it will be provided free of charge.
Rationale and plan for sub-study Part 1: Over nearly 2 years of the program the investigators have tested a systematic outreach strategy for increasing screening completion among uninsured patients, not up to date with screening. Through these carefully evaluated interventions, the investigators have shown that an outreach invitation strategy, particularly when it includes FIT invitations, markedly increases screening completion among the uninsured. Thirty-six percent of individuals invited to complete FIT return the test. The investigators believe this rate may be improved by making changes to the invitation letters. The sub-study hypothesis is that providing information in the letter about the value of the kit and attenuating concern about future cost will further increase FIT and follow-up response rates.
Part 2: In part 2 of the sub-study, participants will receive their FIT results in either a white envelope (normal results, no immediate follow-up necessary) or a red envelope (abnormal result, need to follow-up with physician). The only change to this portion of the study is the color of the envelope patients receive.
Rationale and plan for Part 2: With the current program, the rate of follow-up diagnostic colonoscopy after abnormal FIT is 58%. Since individuals with abnormal FIT have an increased chance of having colorectal cancer, identifying alternate strategies to improve compliance with diagnostic colonoscopy is desirable. Accordingly the sub-study will employ a simple alerting tactic through the color of the envelope (red for abnormal and white for normal). The investigators hypothesize that more patients will follow-up after receiving a positive FIT result as a result of the messaging importance of abnormal tests with a red envelope. Because the sub-study will be employed in 2 predetermined rounds of invitations, investigators will have the opportunity to conduct a pre-post analysis of the follow-up rates to test this hypothesis.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Uninsured
- Participants in John Peter (JPS) Health System medical assistance program for the uninsured.
- One or more visits to a JPS primary care clinic within a year.
- Not up-to-date with colorectal cancer screening
Exclusion Criteria:
- Patients with a history of colorectal cancer or colon resection
- No address and/or phone number on file with JPS
- Incarcerated
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control condition
A control invitation letter similar to the previous standard (non-incentive) invitation with slight wording and grammatical improvements will be mailed to patients randomly assigned to this group.
|
Patients will be mailed a cost condition invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
Patients will be mailed a cost/future condition invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
|
Active Comparator: Cost condition
A control invitation letter with the addition of one line informing participants of the average value of the KIT procedure will be mailed to patients randomly assigned to this group.
|
Patients will be mailed a cost/future condition invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
Patients will be mailed a control invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
|
Active Comparator: Cost/Future condition
An invitation letter with the average value of the KIT procedure and a sentence assuring participants that should a follow-up test be requested, it will also be provided free of charge will be mailed to patients randomly assigned to this group.
|
Patients will be mailed a cost condition invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
Patients will be mailed a control invitation letter to complete a home fecal immunochemical test (FIT) for colorectal cancer screening.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of individuals who complete FIT screening measured by return FIT kit
Time Frame: Within 3 months of invitation
|
The primary outcome will be analyzed using an intention to treat approach.
An "a priori" estimated sample size is 2,124; assigned 1:1:1 via simple randomization, stratified by round of invitation to each of the three intervention groups.
Sample size was constrained by the number of individuals eligible for screening outreach; all eligible individuals during study period will be included in one of the intervention groups.
Assuming a standard intervention group FIT completion rate of 36%, and two-sided alpha=0.125 for each comparison, an estimated 80% power to detect a >8% difference between Condition 1 (standard mailed invitation, n=708) and Condition 2 (n=708), as well as 80% power to detect a >8% difference between Condition 1 (n=708) and Condition 3 (n=708).
|
Within 3 months of invitation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of individuals who receive a positive (abnormal) FIT result that then call to receive additional information about potential follow-up test.
Time Frame: Within 6 months of mailed FIT results letter
|
Within 6 months of mailed FIT results letter
|
|
Percentage of individuals who schedule a pre-operative clinic visit (if recommended).
Time Frame: Within 6 months of mailed FIT results letter
|
Within 6 months of mailed FIT results letter
|
|
Percentage of individuals who complete a colonoscopy (if recommended).
Time Frame: Within 6 months of mailed FIT results letter
|
Within 6 months of mailed FIT results letter
|
|
Pre-post analysis of current results reporting strategy (which will utilize a white envelope for normal results, and a red envelope for abnormal results) to prior generic envelope for FIT result reporting for both normal and abnormal results.
Time Frame: Within 6 months of mailed FIT results letter
|
This will be measured by proportion of individuals with abnormal FIT completing diagnostic colonoscopy pre and post the envelope intervention.
|
Within 6 months of mailed FIT results letter
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Keith E Argenbright, MD, University of Texas Southwestern Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 082012-086 Sub-study
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Colorectal Cancer
-
University of California, San FranciscoCompletedStage IV Colorectal Cancer AJCC v8 | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC... and other conditionsUnited States
-
Fred Hutchinson Cancer CenterNational Cancer Institute (NCI)TerminatedRectal Cancer | Colon Cancer | Cancer Survivor | Colorectal Adenocarcinoma | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC v8 | Stage I Colorectal Cancer AJCC v8 | Stage II Colorectal Cancer AJCC v8 | Stage... and other conditionsUnited States
-
University of Southern CaliforniaNational Cancer Institute (NCI)TerminatedStage IV Colorectal Cancer AJCC v8 | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC... and other conditionsUnited States
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)Active, not recruitingStage IV Colorectal Cancer AJCC v8 | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC... and other conditionsUnited States
-
Wake Forest University Health SciencesNational Cancer Institute (NCI)CompletedCancer Survivor | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC v8 | Stage I Colorectal Cancer AJCC v8 | Stage II Colorectal Cancer AJCC v8 | Stage IIA Colorectal Cancer AJCC v8 | Stage IIB Colorectal... and other conditionsUnited States
-
M.D. Anderson Cancer CenterRecruitingColorectal Adenocarcinoma | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC v8 | Stage... and other conditionsUnited States
-
City of Hope Medical CenterRecruitingColorectal Neoplasms | Colorectal Cancer | Colorectal Adenocarcinoma | Colorectal Cancer Stage II | Colorectal Cancer Stage III | Colorectal Cancer Stage IV | Colorectal Neoplasms Malignant | Colorectal Cancer Stage IUnited States, Japan, Italy, Spain
-
Sidney Kimmel Cancer Center at Thomas Jefferson...United States Department of DefenseActive, not recruitingColorectal Adenoma | Stage III Colorectal Cancer AJCC v8 | Stage IIIA Colorectal Cancer AJCC v8 | Stage IIIB Colorectal Cancer AJCC v8 | Stage IIIC Colorectal Cancer AJCC v8 | Stage 0 Colorectal Cancer AJCC v8 | Stage I Colorectal Cancer AJCC v8 | Stage II Colorectal Cancer AJCC v8 | Stage IIA Colorectal... and other conditionsUnited States
-
University of Roma La SapienzaCompletedColorectal Cancer Stage II | Colorectal Cancer Stage III | Colorectal Cancer Stage IV | Colorectal Cancer Stage 0 | Colorectal Cancer Stage IItaly
-
University of Southern CaliforniaNational Cancer Institute (NCI); AmgenTerminatedStage IV Colorectal Cancer AJCC v7 | Stage IVA Colorectal Cancer AJCC v7 | Stage IVB Colorectal Cancer AJCC v7 | Colorectal Adenocarcinoma | RAS Wild Type | Stage III Colorectal Cancer AJCC v7 | Stage IIIA Colorectal Cancer AJCC v7 | Stage IIIB Colorectal Cancer AJCC v7 | Stage IIIC Colorectal Cancer...United States
Clinical Trials on Cost condition
-
Faculty Sao Leopoldo Mandic CampinasUnknown
-
Konkuk University Medical CenterGlaxoSmithKlineCompletedChronic Obstructive Pulmonary Disease | COPDKorea, Republic of
-
Kocaeli Derince Education and Research HospitalUnknownCost of ICU
-
Faculty Sao Leopoldo Mandic CampinasCompleted
-
University of Texas at AustinStanford UniversityCompleted
-
University of DelawareTerminated
-
VA Ann Arbor Healthcare SystemVA Center for Clinical Management ResearchRecruiting
-
Hospices Civils de LyonRecruiting
-
Sunnybrook Health Sciences CentreCanadian Institutes of Health Research (CIHR)Not yet recruitingType 2 Diabetes Mellitus | Medication Adherence | Medication Compliance | Medication Nonadherence
-
University of UtahCompletedBreast CancerUnited States