Multifaceted Intervention Improves Adherence to Annual Colorectal Cancer Screening in Primarily Latino Community Health Centers


Key Points

  • Fecal occult blood testing was completed by 82% of the intervention group and 37% of the usual-care group.
  • Most of the screening was completed prior to the personal phone call at 3 months after the due date.

Colorectal cancer screening rates are low among Latinos and people living in poverty. In a study reported in JAMA Internal Medicine, Baker et al found that a multifaceted intervention more than doubled adherence to screening with fecal occult blood testing in a largely Latino and uninsured community health center population.

Study Details

In the study, 450 patients from four community health centers in the Erie Family Health Center network (Chicago) who had completed a home fecal occult blood test between March 2011 and February 2012 with a negative test result were randomly assigned to a multifaceted intervention or usual care.

Usual care included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests, and clinician feedback on screening rates.  The intervention group also received a mailed reminder letter, free fecal immunochemical test with low-literacy instructions, and a postage-paid return envelope; an automated telephone and text message reminding them that they were due for screening and that a fecal immunochemical test was being mailed to them; an automated telephone and text reminder at 2 weeks after due date for those who did not return the fecal immunochemical test; and a personal telephone call by a screening navigator after 3 months.

The outcome measure was completion of fecal occult blood testing within 6 months of the due date for annual screening.

The intervention and usual-care groups were balanced for age (mean, 60 years in both), sex (70% and 73% female), race/ethnicity (88% and 91% Latino/Hispanic), preferred language (Spanish for 84% in both), and insurance status (77% and 76% uninsured); there was a nonsignificant difference in number of chronic medical conditions (0 in 36% and 27%, 1 in 32% in both, 2 in 26% and 32%, ≥ 3 in 6% and 9%).

Completion Rates

The fecal occult blood test was completed by 82.2% of intervention patients vs 37.3% of usual-care patients (P < .001). Screening was completed before the due date by 10.2% of the intervention group vs 11.1% of the usual-care group, within 2 weeks after the due date (after initial intervention in intervention group) by 39.6% vs 3.6%, within 2 to 13 weeks (after automated call/text reminder) by 24.0% vs 12.0%, and between 13 and 26 weeks (after personal call) by 8.4% vs 10.7%.

The investigators concluded, “This intervention greatly increased adherence to annual [colorectal cancer] screening; most screenings were achieved without personal calls. It is possible to improve annual [colorectal cancer] screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies.”

David W. Baker, MD, MPH, of the Feinberg School of Medicine, Northwestern University, is the corresponding author for the JAMA Internal Medicine article.

The study was funded by a grant from the Agency for Healthcare Research and Quality. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.