Individuals who self-order colorectal cancer screening kit more likely to complete it

People who ordered a colorectal cancer screening kit through a patient portal were nearly four times more likely to complete it than those who received a kit automatically in the mail, a retrospective observational study showed.

“Colorectal cancer screening is the most important tool we currently have to prevent deaths from colorectal cancer,” Erin E. Hahn, PhD, MPH, a health services researcher with Kaiser Permanente Southern California, told Healio Primary Care. “Improving screening rates even a little can have big impacts on patient lives and cancer outcomes.”

Hahn and colleagues analyzed activity from 176,231 patients within the Kaiser Permanente Southern California health care system. The median age of the patients was 59 years. Among all the patients, 53% were women, 51% were white, 21% were Hispanic/Latino, 11% were Asian, 7% were Black, 7% were unknown and 3% identified as other/mixed race. All patients received an electronic screening reminder embedded with an order button that allowed participants to request a fecal immunochemical test (FIT) kit directly from a patient portal. Those who used the order button were sent a FIT kit immediately; those who did not use the order button were later mailed kits.

The researchers reported in the Journal of General Internal Medicine that approximately 10% of patients requested the kit. Among those in this cohort, 83% completed a FIT kit vs. 37% of patients who did not request a kit. Additional analyses showed those who used the FIT kit button had 3.8 times the odds of completing a FIT kit in comparison to participants who logged into the patient portal during the study period but did not use the button (OR = 3.77; 95% CI, 3.57–3.98). In the nonbutton group, those who did not login to the patient portal during the study period were 75% less likely to complete a FIT kit compared with those who logged in but did not use the FIT kit button. The researchers also reported that the majority of those who used the button were white and aged 71 years and older. The mean time it took users to complete the FIT kit was 56 days among those who used the button vs. 90 days among those who did not use the button.

In addition, 71% of the button users were eligible for a FIT kit in the year before the button was available. Of those, 63% completed a FIT kit before the button was available and 87% completed the kit in the year after it became available (McNemar’s test P < .0001), translating to an increase of 2,876 patients.

“We were surprised to find that the button resulted in people completing their screening who had not been screened in the year before. This shows that the button may encourage people to get screened even if they have not been doing so regularly,” Hahn said. “There is a robust body of recent research showing how important multi‐modal patient outreach —using telephone, texting, email, mail and patient portals together — can improve colorectal cancer screening rates. Our study is a piece of this, demonstrating that self‐ordering home screening kits is feasible and successful.”