Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening
- 505 Downloads
Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments.
To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice.
Pragmatic randomized trial.
Men and women aged 50–74 years past due for CRC screen and women aged 40–74 years past due for BC screening.
We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call).
Documentation of mammography or colorectal cancer screening at 52 weeks following randomization.
Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2–4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1–3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1–3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0–3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates.
The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.
KEY WORDScancer screening colorectal cancer breast cancer outreach inreach
All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline.
This project was supported by the American Cancer Society - RSGT-08-077-01-CPHPS.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41–5.Google Scholar
- 2.Sabatino SA, Lawrence B, Elder R, et al. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. 2012;43(1):97–118. doi: 10.1016/j.amepre.2012.1004.1009.CrossRefPubMedGoogle Scholar
- 7.Hendren S, Winters P, Humiston S, et al. Randomized controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice. JGIM. 2013. doi: 10.1007/s11606-013-2506-1.
- 8.U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, American Community Survey, Census of Population and Housing, County Business Patterns, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report, Census of Governments 2012; http://quickfacts.census.gov/qfd/states/36/3663000.html. Accessed 7/27/2013.
- 12.Baron RC, Melillo S, Rimer BK, et al. Intervention to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers a systematic review of provider reminders. Am J Prev Med. 2010;38(1):110–7. doi: 10.1016/j.amepre.2009.1009.1031.CrossRefPubMedGoogle Scholar
- 21.Agency for Healthcare Research and Quality. Patient Centered Medical Home Resource Center. http://pcmh.ahrq.gov. Accessed 7/27/2013.