Combination of patient, provider outreach boosts CRC screening in high-risk individuals
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CHICAGO — A multicomponent strategy, which included patient and provider outreach, increased colorectal cancer screening in individuals overdue for colonoscopy who have a family history of CRC, according to data at Digestive Disease Week.
“In the United States, CRC is the third most diagnosed cancer and the second most common cause of cancer-related mortality,” Shailavi Jain, MD, an internal medicine resident at the University of California, Los Angeles, told Healio. “Family history of CRC contributes to one-third of CRC cases in the United States.”
She continued, “CRC incidence and mortality in the U.S. have decreased with the implementation of various health system interventions aimed at increasing CRC screening rates; however, these interventions often exclude high-risk individuals, including those with a family history of CRC. In fact, there are few known effective interventions to increase screening participation in this high-risk group.”
Seeking to identify ways to improve screening participation in high-risk individuals, Jain and colleagues conducted a study at an academic health center and included 150 primary care patients who were overdue for colonoscopy and excluded from the center’s fecal immunochemical test (FIT) outreach.
To compare outreach strategies, researchers randomized patients to two intervention groups: In group 1 (mean age, 60.6 years; 24.3% men; n = 74), an electronic health record reminder was sent to the patient’s primary care provider with a pended colonoscopy order as well reminder to the patient via mail and patient portal to schedule a colonoscopy 2 and 7 weeks later. Group 2 (mean age, 61.9 years; 40.8% men; n = 76) received the same outreach as group 1 as well as an additional education document on familial risk for CRC and information about the colonoscopy procedure.
The primary outcome was completion of colonoscopy at week 26, while secondary outcomes included the rate of colonoscopies ordered and scheduled at week 26.
According to results, colonoscopy completion rates were 12.2% in group 1 and 14.5% in group 2, with 52 colonoscopies ordered (70.3%) in group 1 compared with 57 (76%) in group 2. In addition, 17 colonoscopies were scheduled (23%) in group 1 vs. 12 (15.8%) in group 2.
“This study highlights the need for more targeted interventions to increase CRC screening participation in these high-risk and understudied individuals with a family history of CRC,” Jain said. “In both intervention arms of this study, previously unscreened patients with a family history of CRC completed their screening. This suggests that we can engage individuals with a family history of CRC who have been previously resistant to screening with a combination of provider and patient outreach.”
She added, “However, importantly, addition of the educational resource did not appear necessary to achieve the intended results, suggesting that we may not need to invest in these extra resources to get high-risk individuals screened. Implementing even very simple interventions works.”
Jain noted that future interventions should be refined and potentially automated in the health system and electronic health record, making distribution to larger patient populations possible.
“Going forward, these results will hopefully encourage other health systems to implement targeted multicomponent interventions, including both patient and provider outreach, to increase CRC screening participation in patients with a family history of CRC,” Jain said. “Increasing screening participation in these high-risk individuals that make up one-third of CRC cases will, in turn, improve overall patient outcomes.”
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Jain S, et al. Abstract 118: Impact of a multicomponent health system intervention to increase colorectal cancer screening participation in patients with a family history of colorectal cancer. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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