Mailed FIT Outreach Boosts CRC Screening in Rural Areas

TOPLINE:

A mailed fecal immunochemical test (FIT) outreach followed by patient navigation for those with a positive test increased colorectal cancer (CRC) screening participation at 6 months compared with usual care, according to a randomized clinical trial of rural Medicaid enrollees. However, the use of FIT and participation in follow-up colonoscopy remained low.

METHODOLOGY:

• The US Preventive Services Task Force recommends CRC screening starting at age 45 years, but participation is low, particularly among rural residents and Medicaid enrollees.
• To improve CRC screening rates for these populations, the SMARTER CRC trial assessed the effectiveness of a mailed FIT program. The trial randomized 28 rural clinics in Oregon that were affiliated with three Medicaid health plans to a mailed FIT intervention (n = 14) and usual care (n = 14).
• Usual care included offering CRC screening to patients at clinic visits and having clinic staff contact and refer patients with abnormal FIT results to clinicians offering colonoscopy services. The intervention included these usual care efforts plus mailed FIT outreach and patient navigation for follow-up colonoscopy after an abnormal result.
• All 1489 intervention-eligible enrollees were mailed an FIT; another 3001 enrollees due for CRC screening were allocated to the usual care group.
• The primary outcome was CRC screening completion within 6 months. Implementation outcomes included FIT mailing rates, advance notifications, reminders, and patient navigation for abnormal results.

TAKEAWAY:

• Completion of any CRC screening at 6 months was significantly higher inr the intervention clinics than in the usual care clinics (11.8% vs 4.5%; P < .001). FIT completion at 6 months was higher in the intervention clinics (8.5% vs 2.2%; P < .001).
• Among enrollees mailed an FIT, the return rate was 12.2% (181 of 1489); among those who were mailed an FIT and who received a reminder, the return rate was higher — 16.7% (149 of 893) at 6 months.
• Among 34 enrollees with an abnormal FIT result, the follow-up colonoscopy completion rate was significantly higher in the intervention group (43.3%; 12 of 27) than in the usual care group (15.4%; 1 of 7); P = .04.
• Implementation rates were 100% for FIT mailings, 88.5% for advance notifications, and 78.1% for reminders. Of 19 enrollees with an abnormal FIT result, 11 received patient navigation.

IN PRACTICE:

Although the intervention boosted participation in CRC screening, “more efforts are needed to address low participation in both FIT testing and follow-up colonoscopy,” the authors wrote.

“The absolute proportions of screening completion in the intervention group are still well below national targets, with 12% of participants who received a mailed FIT kit returning the test and 43% of patients with a positive FIT result completing a colonoscopy,” Michael Dougherty, MD, MSCR, University of North Carolina at Chapel Hill, wrote in an invited commentary. However, “the study design of the trial left much of the intervention in the hands of the individual clinics, with only 78% of patients receiving any reminder to complete their FIT and only 58% of patients with a positive FIT result receiving any component of the patient navigation intervention.”

SOURCE:

The study, led by Gloria D. Coronado, PhD, University of Arizona Cancer Center in Tucson, Arizona, was published online in JAMA Network Open.

LIMITATIONS:

The limitations included under captured screening events, especially for individuals who disenrolled from Medicaid. In addition, incomplete intervention delivery might have had an impact on effectiveness.

DISCLOSURES:

The study was supported by grants from the National Institutes of Health and the National Center for Advancing Translational Sciences. One author reported receiving grants from Guardant Health outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.