Factors Affecting Adherence in a Pragmatic Trial of Annual Fecal Immunochemical Testing for Colorectal Cancer

Background Colorectal cancer screening by fecal immunochemical test (FIT) reduces the burden of colorectal cancer. However, effectiveness relies on annual adherence, which presents challenges for clinic staff and patients. Objective Describe FIT return rates and identify factors associated with FIT...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2019-06, Vol.34 (6), p.978-985
Main Authors: Nielson, Carrie M., Vollmer, William M., Petrik, Amanda F., Keast, Erin M., Green, Beverly B., Coronado, Gloria D.
Format: Article
Language:English
Subjects:
Adhesion
Aged
Cancer
Cancer screening
Colon
Colon cancer
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - diagnosis
Colorectal Neoplasms - psychology
Early Detection of Cancer - methods
Early Detection of Cancer - psychology
Female
Follow-Up Studies
Health care facilities
Health facilities
Humans
Initial fit
Internal Medicine
Male
Medical screening
Medicine
Medicine & Public Health
Middle Aged
Occult Blood
Original Research
Patient Compliance - psychology
Patients
Tobacco
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Summary:Background Colorectal cancer screening by fecal immunochemical test (FIT) reduces the burden of colorectal cancer. However, effectiveness relies on annual adherence, which presents challenges for clinic staff and patients. Objective Describe FIT return rates and identify factors associated with FIT adherence over 2 years in a mailed FIT outreach program in federally qualified health centers. Design Observational study nested in the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) trial. Five thousand one hundred ninety-five patients had an initial FIT order and were followed for ≥ 2 years (3574 also had a FIT order in the second year). Main Measures FIT return percent in each year and patient- and neighborhood-level characteristics associated with FIT adherence. Key Results Overall, the proportion of FIT orders that were completed was 46% in the patients’ first year and 41% in the patients’ second year. Of the 5195 patients with a FIT order in year 1, 3574 (69%) also had a FIT order in year 2 (71% of year 1 adherers and 67% of year 1 non-adherers, p  = 0.009). Among those with a FIT order in the second year, the FIT return rate was about twice as high among those who were adherent in the first year (952/1674, or 57%) as among those who were not (531/1900, or 28%, p  
ISSN:0884-8734
1525-1497
1525-1497
DOI:10.1007/s11606-018-4820-0