Automated Reminders Enhance Mailed Fecal Immunochemical Test Completion Among Veterans: a Randomized Controlled Trial

• Published in: Journal of general internal medicine : JGIM 2024-01, Vol.39 (1), p.113-119
• Main Authors: Deeds, Stefanie, Schuttner, Linnaea, Wheat, Chelle, Gunnink, Eric, Geyer, John, Beste, Lauren, Chen, Anders, Dominitz, Jason A., Nelson, Karin, Reddy, Ashok
• Format: Article
• Language: English
• Subjects: Automation; Cancer; Cancer screening; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Early Detection of Cancer - methods; Female; Humans; Internal Medicine; Male; Mass Screening; Medical screening; Medicine; Medicine & Public Health; Messages; Middle Aged; Occult Blood; Original Research; Prospective Studies; Quality control; Reminder Systems; Response rates; Risk; Short message service; Telephone calls; Text Messaging; Veterans
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08409-8

Background The Veterans Affairs (VHA) is working to establish a population-based colorectal cancer screening program for average-risk patients using mailed fecal immunochemical testing (FIT). However, low response rates to mailed FIT may hinder success. Key features of mailed FIT programs, including the use of reminders, differ among various national programs, with limited evidence among veterans. Objective We sought to test whether using reminders, either via telephone call or text message, was effective in improving mailed FIT response rates. Design We conducted a prospective, randomized quality improvement trial ( ClinicalTrials.gov NCT05012007). Veterans who had not returned a FIT within 2 weeks of receiving the kit were randomized to one of three groups: (1) control (no reminder); (2) an automated telephone call reminder; or (3) an automated text message reminder. Participants A total of 2658 veterans enrolled at VA Puget Sound Health Care System who were aged 45–75 and had an average risk of colorectal cancer. Interventions A single automated telephone call or text message reminder prompting veterans to return the FIT kit. Main Measures Our primary outcome was FIT return at 90 days and our secondary outcome was FIT return at 180 days. Key Results Participant average age was 62 years, 88% were men, and 66% White. At 90 days, both the phone and text reminder interventions had higher FIT return rates compared to control (intention-to-treat results (ITT): control 28%, phone 39%, text 38%; p