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Deeds S, Schuttner L, Wheat C, Gunnink E, Geyer J, Beste L, Chen A, Dominitz JA, Nelson K, Reddy A. Automated Reminders Enhance Mailed Fecal Immunochemical Test Completion Among Veterans: a Randomized Controlled Trial. J Gen Intern Med 2024; 39:113-119. [PMID: 37731137 PMCID: PMC10817873 DOI: 10.1007/s11606-023-08409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
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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Affiliation(s)
- Stefanie Deeds
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA.
| | - Linnaea Schuttner
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Chelle Wheat
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Eric Gunnink
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - John Geyer
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Lauren Beste
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Anders Chen
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Jason A Dominitz
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
- National Gastroenterology and Hepatology Program, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
- Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA
| | - Karin Nelson
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Ashok Reddy
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Puget Sound Health Care System, Veterans Health Administration Department of Veterans Affairs, 1660 S. Columbian Way (S-152), Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Vernon SW, Del Junco DJ, Coan SP, Murphy CC, Walters ST, Friedman RH, Bastian LA, Fisher DA, Lairson DR, Myers RE. A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans. Contemp Clin Trials 2021; 105:106392. [PMID: 33823295 DOI: 10.1016/j.cct.2021.106392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. OBJECTIVES To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. METHODS Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. RESULTS After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). CONCLUSIONS In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.
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Affiliation(s)
- Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, United States.
| | - Deborah J Del Junco
- Department of Surgery, Center for Translational Injury Research, The University of Texas McGovern Medical School, Houston, TX, United States
| | - Sharon P Coan
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, United States
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Scott T Walters
- Health Behavior and Health Systems, University of North Texas Health Science Center, Ft. Worth, TX, United States
| | - Robert H Friedman
- Medical Information Systems Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Lori A Bastian
- General Internal Medicine, VA Connecticut, West Haven, CT 06516 and Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | | | - David R Lairson
- Department of Management Policy and Community Health, UTHealth School of Public Health, Houston, TX, United States
| | - Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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