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Calls beat texts, letters as colon cancer screening reminders
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Live phone calls were significantly more effective than text messages or letters for reminding people to complete their fecal immunochemical tests for at-home colorectal cancer screening in a randomized controlled trial.
Surprisingly, text messages were the least effective strategy for reminding this cohort of screening aged adults (50-75 years) to complete and return their tests.
“We knew that these patients are not as text savvy as younger patients, but we didn’t expect text messaging to do so poorly, compared to the other strategies,” Gloria Coronado, PhD, cancer disparities researcher with the Kaiser Permanente Center for Health Research, said in a press release. “Text messaging is a relatively inexpensive way to send patient reminders, but for this group it was also relatively ineffective.”
As part of a direct-mail fecal immunochemical test (FIT) program at Sea Mar Community Health Centers in Seattle, Washington, 2,478 eligible adults of screening age (50-75 years) who were not up to date with colorectal cancer screening were mailed an introductory letter and a FIT, which were completed and returned by 10% of recipients within 3 weeks.
To compare reminder strategies, Coronado and colleagues randomly assigned the remaining 90% to receive one of seven reminders, including a phone call from a clinic outreach employee, two automated phone calls, two text messages, a reminder letter, or a combination of strategies.
After reminders were sent, an additional 25.5% of recipients completed and returned their FITs, for an overall return rate of 32.7%.
The live phone call was the most effective reminder strategy, with 32% of patients who received a call completing and returning their FIT within 6 months (OR = 1.51; 95% CI, 1.03-2.21 vs. letter). In contrast, the text message reminders were the least effective, with just 17% returning their FIT (OR = 0.66; 95% CI, 0.43-0.99).
However, the effectiveness of different reminder strategies varied by language, as recipients received the interventions in their preferred language. For example, English speaking participants more often responded to the single phone call (OR = 2.17; 95% CI, 1.31-3.59), and Spanish speaking participants more often responded to the combination of one live phone call and two automated calls (OR = 3.45; 95% CI, 1.42-8.39).
Coronado noted in the press release that English speakers may have been more likely to ignore the automated calls, whereas Spanish speakers appeared to appreciate the additional contacts.
“The phone calls may help to build trust or confianza, which is an important value and motivator for care-seeking among Hispanics,” Ricardo Jimenez, MD, medical director of Sea Mar Community Health Centers, said in the press release.
This finding shows that a single reminder intervention may not work for all patients, according to Coronado. “We need to design interventions tailored to the patient’s language and cultural preference,” she said. – by Adam Leitenberger
Disclosures: Coronado reports she previously served as a co-investigator on a study funded by Epigenomics.
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