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

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Abstract

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<0.001). At 180 days, FIT kit return remained higher in the reminder interventions (ITT: control 32%, phone 42%, text 40%; p<0.001).

Conclusions

Automated reminders increased colorectal cancer screening completion among average-risk veterans. An automated phone call or text message was equally effective. VHA facilities seeking to implement a mailed FIT program should consider using phone or text reminders, depending on available resources.

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Acknowledgements

This work was made possible through operational support from VA Puget Sound Health Care System Leadership.

Funding

This work was made possible through operational funding from VA Puget Sound Health Care System Leadership. Additionally, this work was funded by the Primary Care Analytics Team through the Veterans Health Administration Office of Primary Care. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Stefanie Deeds MD, Linnaea Schuttner MD MS, John Geyer MD, Lauren Beste MD, Anders Chen MD MS, Karin Nelson MD MS & Ashok Reddy MD MS

  2. Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA

    Stefanie Deeds MD, Linnaea Schuttner MD MS, Chelle Wheat PhD, Eric Gunnink MS, John Geyer MD, Lauren Beste MD, Anders Chen MD MS, Jason A. Dominitz MD, MHS, Karin Nelson MD MS & Ashok Reddy MD MS

  3. National Gastroenterology and Hepatology Program, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA

    Jason A. Dominitz MD, MHS

  4. Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA

    Jason A. Dominitz MD, MHS

  5. Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA

    Karin Nelson MD MS & Ashok Reddy MD MS

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  1. Stefanie Deeds MD
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Correspondence to Stefanie Deeds MD.

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Deeds, S., Schuttner, L., Wheat, C. et al. Automated Reminders Enhance Mailed Fecal Immunochemical Test Completion Among Veterans: a Randomized Controlled Trial. J GEN INTERN MED 39, 113–119 (2024). https://doi.org/10.1007/s11606-023-08409-8

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