Randomized controlled trial of the impact of intensive patient education on compliance with fecal occult blood testing

Abstract

Background: Randomized controlled trials have demonstrated that fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality. However, patient compliance with FOBT is low and this is one of the major barriers to CRC screening.

Objective: To determine whether intensive patient education increases FOBT card return rates.

Design: Randomized controlled trial.

Setting: Department of Veterans Affairs primary care clinic.

Participants: Seven hundred eighty-eight patients who were referred for FOBT.

Interventions: Patients were randomly allocated to receive either intensive (n=396) or standard (n=392) patient education. Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening, were instructed on how to properly collect stool specimens for FOBT, and were given a 2-page handout on CRC screening. Patients in the standard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT.

Results: Patients in the intensive education group were more likely to return the FOBT cards (65.9% vs 51.3%; P<.001) and called the clinic with additional questions less often (1.5% vs 5.9%; P=.001) than the standard education group. The median time to return the FOBT cards was significantly shorter in the intensive education group (36 vs 143 days; P<.001 by log-rank test). However, the proportion of patients who had a positive FOBT did not differ in the two groups (4.6% vs 6.0%; P=.51).

Conclusions: Intensive patient education significantly improved patient compliance with FOBT. Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted.

Figures

FIGURE 1

Flow of participants through the study.

FIGURE 2

Kaplan-Meier analysis of time to return FOBT cards. The median time to return the FOBT cards was 36 days in the intensive education group (solid line) compared with 143 days in the standard education group (dashed line), and this difference was statistically significant (P <.001 by log-rank test).