Journal of Community Health

, Volume 39, Issue 2, pp 239–247 | Cite as

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

  • Jennifer A. Schlichting
  • Michelle A. Mengeling
  • Nader M. Makki
  • Ashish Malhotra
  • Thorvardur R. Halfdanarson
  • J. Stacey Klutts
  • Barcey T. Levy
  • Peter J. Kaboli
  • Mary E. Charlton
Original Paper

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.

Keywords

Colorectal cancer screening Fecal immunochemical test Intervention Cost comparison 

References

  1. 1.
    American Cancer Society. (2013). Colorectal cancer overview. Retrieved 2013, from http://www.cancer.org/cancer/colonandrectumcancer/overviewguide/colorectal-cancer-overview-key-statistics.
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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. 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.CrossRefGoogle Scholar
  18. 18.
    Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. Journal of the National Cancer Institute, 89(19), 1406–1422.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Jennifer A. Schlichting
    • 1
    • 2
  • Michelle A. Mengeling
    • 1
    • 2
    • 4
  • Nader M. Makki
    • 4
  • Ashish Malhotra
    • 1
    • 2
  • Thorvardur R. Halfdanarson
    • 5
  • J. Stacey Klutts
    • 6
    • 7
  • Barcey T. Levy
    • 3
    • 8
  • Peter J. Kaboli
    • 1
    • 2
    • 4
  • Mary E. Charlton
    • 1
    • 2
    • 3
  1. 1.VA Office of Rural Health, Rural Health Resource Center – Central RegionIowa City VA Healthcare SystemIowa CityUSA
  2. 2.Comprehensive Access and Delivery Research and Evaluation (CADRE) CenterIowa City VA Healthcare SystemIowa CityUSA
  3. 3.Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityUSA
  4. 4.Division of General Internal Medicine, Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA
  5. 5.Division of Oncology, Department of Internal MedicineMayo ClinicScottsdaleUSA
  6. 6.Department of PathologyUniversity of Iowa Carver College of MedicineIowa CityUSA
  7. 7.Pathology and Laboratory MedicineIowa City VA Healthcare SystemIowa CityUSA
  8. 8.Department of Family MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA

Personalised recommendations