Advanced outreach campaign improves CRC screening rates
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SAN DIEGO — Pre-alert text message notification followed by mailed fecal immunochemical test kits improved population-level screening for colorectal cancer during COVID-19, according to research.
“The majority of colorectal cancer morbidity and mortality is preventable through early detection via screening, and while efforts have been made across the country to increase screening, the emergence of COVID-19 has drastically changed this landscape,” Sara Zhou, BA, a second-year medical student at the University of California, San Francisco, told attendees at Digestive Disease Week 2022. “These trends are predicted to preferentially affect vulnerable populations who historically shoulder increased burdens of both COVID-19 and colorectal cancer.”
Seeking to evaluate the effectiveness of a CRC outreach campaign, Zhou and colleagues targeted patients aged 50 to 75 years from 11 primary care clinics within the San Francisco Health Network who had previously completed a fecal immunochemical test (FIT) and were overdue for CRC screening. From November 2020 to April 2021, patients received a pre-alert text message notification that they would be mailed a FIT kit unless they opted out of receiving a kit (n = 371) or opted in to receive a kit (n = 522). The primary studied outcome was screening uptake at 3 months.
At study conclusion, 96.5% of patients in the opt-out group and 19.3% of patients in the opt-in group received FIT kits via mail. Researchers observed increased screening uptake in the opt-out group compared with the opt-in group (58.8% vs. 18%; 95% CI, 34.8-46.8), accounting for a 40.8% difference, as well as lower screening rates for patients in both the opt-out and opt-in groups among Black/African American patients (33.3% and 9.4%, respectively) compared with Hispanic/Latino patients (53.3% and 26.7%) and Asian patients (66.7% and 26.7%).
While the intention of the study was to increase CRC screening rates among disparate populations, namely Black and African American patients, the preferential inclusion of patients with a prior history of FIT completion was a limitation.
“Disparities are only addressed when we target populations who had never completed screening before,” Zhou said. “Therefore, future intervention should target screening populations who have low rates of screening in order to improve completion rates for everyone.”
Overall, text message outreach followed by mailed FIT kits was an effective method of increasing CRC screening rates, researchers concluded.
“More specifically, while opt-out messaging was significantly more effective at increasing screening uptake over opt in-messaging, we found that opt-in messaging resulted in high completion rates for those who opted in to doing so,” Zhou said.
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Zhou S, et al. Abstract 228. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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