Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Findings from the PROMPT Study

Abstract

Background: Improving uptake of colorectal cancer screening has the potential of saving thousands of lives. We compared the effectiveness of automated and live prompts and reminders as part of a mailed fecal immunochemical test (FIT) outreach program.

Design and methods: Participants were 1767 adults aged 50 to 75 eyars who were not up-to-date with colorectal cancer screening recommendations at a participating community health center clinic. In addition to a mailed FIT kit, participants were randomized to receive (1) a text message prompt and 2 automated phone call reminders (automated condition); (2) up to 3 live call reminders (live condition); or (3) a text message prompt, 2 automated call reminders, and up to 3 live reminders (combined automated plus live condition). We assessed FIT completion rates in each group 6 months following randomization.

Key results: Nearly one-third of participants completed an FIT within 6 months. Compared with adults allocated to the automated condition, FIT completion rates were higher in adults allocated to the live condition (32.3% vs 26.0%; adjusted difference, 6.3 percentage points; 95% CI, 1.1-11.4) and in adults allocated to the combined automated plus live condition (35.7% vs 26.0%; adjusted difference, 9.7 percentage points; 95% CI, 4.4-14.9). The number of kits needed to mail to achieve a completed FIT ranged from 2.8 in the combined automated plus live condition to 3.8 in the automated condition.

Conclusions: Among unscreened individuals in this population, live phone call reminders either alone or in combination with automated prompts and reminders outperformed automated approaches alone.

Trial registration: ClinicalTrials.gov NCT03167125.

Keywords: Colon Cancer; Colorectal Cancer; Community Health Centers; Early Detection of Cancer; Hispanic Americans; Occult Blood; Text Messaging.

Conflict of interest statement

Conflict of interest: From November 2014 to August 2015, Dr. Coronado. served as a coinvestigator on an industry-funded study to evaluate patient adherence to an experimental blood test for colorectal cancer. The study was funded by EpiGenomics. From September 2017 to June 2019, Dr. Coronado has served as the principal investigator on an industry-funded study to compare the clinical performance of an experimental FIT to a Food and Drug Administration-approved FIT. This study is funded by Quidel Corporation. All other authors declare no conflicts of interest.

© Copyright 2019 by the American Board of Family Medicine.

Figures

Figure 1.

CONSORT Diagram