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Increasing Colorectal Cancer Screening in an Overdue Population: Participation and Cost Impacts of Adding Telephone Calls to a FIT Mailing Program

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Abstract

Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.

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References

  1. American Cancer Society. (2013). Colorectal cancer overview. Retrieved 2013, from http://www.cancer.org/cancer/colonandrectumcancer/overviewguide/colorectal-cancer-overview-key-statistics.

  2. Maciosek, M. V., Solberg, L. I., Coffield, A. B., Edwards, N. M., & Goodman, M. J. (2006). Colorectal cancer screening: Health impact and cost effectiveness. American Journal of Preventive Medicine, 31(1), 80–89.

    Article  PubMed  Google Scholar 

  3. U. S. Preventive Services Task Force. (2008). Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 149(9), 627–637.

    Article  Google Scholar 

  4. Klabunde, C. N., Joseph, D. A., King, J. B., White, A., & Plescia, M. (2013). Vital signs: Colorectal cancer screening test use—United States, 2012. MMWR. Morbidity and Mortality Weekly Report, 62(44), 881–888.

    Google Scholar 

  5. Garcia-Dominic, O., Lengerich, E. J., Wray, L. A., Parrott, R., Aumiller, B., Kluhsman, B., et al. (2012). Barriers to CRC screening among Latino adults in Pennsylvania: ACCN results. American Journal of Health Behavior, 36(2), 153–167.

    Article  PubMed  Google Scholar 

  6. Klabunde, C. N., Schenck, A. P., & Davis, W. W. (2006). Barriers to colorectal cancer screening among Medicare consumers. American Journal of Preventive Medicine, 30(4), 313–319.

    Article  PubMed  Google Scholar 

  7. Levy, B. T., Dawson, J., Hartz, A. J., & James, P. A. (2006). Colorectal cancer testing among patients cared for by Iowa family physicians. American Journal of Preventive Medicine, 31(3), 193–201.

    Article  PubMed  Google Scholar 

  8. McLachlan, S. A., Clements, A., & Austoker, J. (2012). Patients’ experiences and reported barriers to colonoscopy in the screening context—a systematic review of the literature. Patient Education and Counseling, 86(2), 137–146.

    Article  PubMed  Google Scholar 

  9. Wee, C. C., McCarthy, E. P., & Phillips, R. S. (2005). Factors associated with colon cancer screening: The role of patient factors and physician counseling. Preventive Medicine, 41(1), 23–29.

    Article  PubMed  Google Scholar 

  10. Long, M. D., Lance, T., Robertson, D., Kahwati, L., Kinsinger, L., & Fisher, D. A. (2012). Colorectal cancer testing in the national Veterans Health Administration. Digestive Diseases and Sciences, 57(2), 288–293.

    Article  PubMed  Google Scholar 

  11. VHA Office of Rural Health. (2013). Fact Sheet: Information about the Office of Rural Health and Rural Veterans. Retrieved 2013, from http://www.ruralhealth.va.gov/docs/factsheets/ORH_FactSheet_General_April2013.pdf.

  12. Malhotra, A., Vaughan-Sarrazin, M., Charlton, M. E., & Rosenthal, G. E. (2014). Comparison of colorectal cancer screening in veterans based on the location of primary care clinic. Journal of Primary Care and Community Health, 5(1), 24–29.

    Article  PubMed  Google Scholar 

  13. Smith, A., Young, G. P., Cole, S. R., & Bampton, P. (2006). Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a sensitive guaiac-based fecal occult blood test in detection of colorectal neoplasia. Cancer, 107(9), 2152–2159.

    Article  PubMed  Google Scholar 

  14. Dancourt, V., Lejeune, C., Lepage, C., Gailliard, M. C., Meny, B., & Faivre, J. (2008). Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms. European Journal of Cancer, 44(15), 2254–2258.

    Article  CAS  PubMed  Google Scholar 

  15. van Rossum, L. G., van Rijn, A. F., Laheij, R. J., van Oijen, M. G., Fockens, P., van Krieken, H. H., et al. (2008). Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology, 135(1), 82–90.

    Article  PubMed  Google Scholar 

  16. Charlton, M. E., Mengeling, M. A., Halfdanarson, T. R., Makki, N. M., Malhotra, A., Klutts, J. S., et al. (2013). Evaluation of a home-based colorectal cancer screening intervention in a rural state. The Journal of Rural Health (in press). Epub ahead of print retrieved December 20, 2013, from http://onlinelibrary.wiley.com/doi/10.1111/jrh.12052/pdf, http://ajrcmb.atsjournals.org/cgi/content/abstract/2004-0309OCv1.

  17. Levy, B. T., Daly, J. M., Xu, Y., & Ely, J. W. (2012). Mailed fecal immunochemical tests plus educational materials to improve colon cancer screening rates in Iowa Research Network (IRENE) practices. The Journal of the American Board of Family Medicin, 25(1), 73–82.

    Article  Google Scholar 

  18. Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. Journal of the National Cancer Institute, 89(19), 1406–1422.

    Article  CAS  PubMed  Google Scholar 

  19. Daly, J. M., Levy, B. T., Merchant, M. L., & Wilbur, J. (2010). Mailed fecal-immunochemical test for colon cancer screening. Journal of Community Health, 35(3), 235–239.

    Article  PubMed  Google Scholar 

  20. Church, T. R., Yeazel, M. W., Jones, R. M., Kochevar, L. K., Watt, G. D., Mongin, S. J., et al. (2004). A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening. Journal of the National Cancer Institute, 96(10), 770–780.

    Article  PubMed  Google Scholar 

  21. Rauscher, G. H., Johnson, T. P., Cho, Y. I., & Walk, J. A. (2008). Accuracy of self-reported cancer-screening histories: A meta-analysis. Cancer Epidemiology, Biomarkers and Prevention, 17(4), 748–757.

    Article  PubMed  Google Scholar 

  22. Quintero, E., Castells, A., Bujanda, L., Cubiella, J., Salas, D., Lanas, A., et al. (2012). Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. New England Journal of Medicine, 366(8), 697–706.

    Article  CAS  PubMed  Google Scholar 

  23. Janssens, A. C., Henneman, L., Detmar, S. B., Khoury, M. J., Steyerberg, E. W., Eijkemans, M. J., et al. (2012). Accuracy of self-reported family history is strongly influenced by the accuracy of self-reported personal health status of relatives. Journal of Clinical Epidemiology, 65(1), 82–89.

    Article  PubMed  Google Scholar 

  24. Ozanne, E. M., O’Connell, A., Bouzan, C., Bosinoff, P., Rourke, T., Dowd, D., et al. (2012). Bias in the reporting of family history: Implications for clinical care. Journal of Genetic Counseling, 21(4), 547–556.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Stacy Wittrock and Ashley Cozad for their efforts in coordinating this study. We would also like to acknowledge Lindsey Davenport-Landry in the Iowa City VA laboratory for her work in managing all of the laboratory aspects of this project. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR), and the VA Health Services Research and Development (HSR&D) Service, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) (CIN 13–412). The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. VA Office of Rural Health, Rural Health Resource Center – Central Region, Iowa City VA Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, USA

    Jennifer A. Schlichting, Michelle A. Mengeling, Ashish Malhotra, Peter J. Kaboli & Mary E. Charlton

  2. Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Healthcare System, Iowa City, IA, USA

    Jennifer A. Schlichting, Michelle A. Mengeling, Ashish Malhotra, Peter J. Kaboli & Mary E. Charlton

  3. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA

    Barcey T. Levy & Mary E. Charlton

  4. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Michelle A. Mengeling, Nader M. Makki & Peter J. Kaboli

  5. Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA

    Thorvardur R. Halfdanarson

  6. Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    J. Stacey Klutts

  7. Pathology and Laboratory Medicine, Iowa City VA Healthcare System, Iowa City, IA, USA

    J. Stacey Klutts

  8. Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Barcey T. Levy

Authors
  1. Jennifer A. Schlichting
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  2. Michelle A. Mengeling
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  3. Nader M. Makki
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  4. Ashish Malhotra
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  5. Thorvardur R. Halfdanarson
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  6. J. Stacey Klutts
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  7. Barcey T. Levy
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  8. Peter J. Kaboli
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  9. Mary E. Charlton
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Corresponding author

Correspondence to Mary E. Charlton.

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Schlichting, J.A., Mengeling, M.A., Makki, N.M. et al. Increasing Colorectal Cancer Screening in an Overdue Population: Participation and Cost Impacts of Adding Telephone Calls to a FIT Mailing Program. J Community Health 39, 239–247 (2014). https://doi.org/10.1007/s10900-014-9830-1

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  • DOI: https://doi.org/10.1007/s10900-014-9830-1

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