Primer Message Boosts Colorectal Cancer Screening Rates

Megan Brooks

February 04, 2022

Researchers have found a simple, low-cost way to get more adults to complete a fecal immunochemical test (FIT) to screen for colorectal cancer (CRC).

In a randomized controlled trial, patients who received an electronic "primer" message through their patient portal before the test kit arrived in their mailbox were more apt to complete and return the test than peers who didn't get the electronic message.

"We were thrilled by the magnitude of the impact," Gregory Goshgarian, MSc, MPH, and Daniel Croymans, MD, with the Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, said in a joint email to Medscape Medical News.

At UCLA Health, "including a primer patient portal message is now standard practice for our FIT mailer program," they added.

Their study was published online today in JAMA Network Open.

Heads-Up Message Boosts Compliance

CRC screening rates in the United States remain well below the national benchmark of 80%, and COVID-19 hasn't helped. As a result, multiple medical and professional societies have emphasized the use of a mailed FIT outreach program.

As part of the outreach program, researchers at UCLA Health developed an electronic primer message within the electronic patient portal to alert patients due for CRC screening that they would be receiving a FIT kit in the mail.

They tested the impact of the primer messages in a randomized controlled trial involving 2339 adults (mean age, 59 years, 57.5% women). Out of these, 1157 received the standard mailed FIT kit (control group) and 1182 received the standard mailed FIT kit plus a primer message sent through their personal patient portal.

Adding the primer message significantly increased the FIT completion rate at 6 months by 5.5%, with rates of 37.6% in the intervention group vs 32.1% in the control group.

After adjusting for patient demographics, the primer (versus no primer) led to significantly increased odds of completing CRC screening (adjusted odds ratio [OR]: 1.29; 95% CI, 1.08 - 1.53; P = .004).

The primer message also shortened the time to FIT screening by 3 days (35 days with the primer vs 38 days without).

Goshgarian and Croymans believe the priming messages worked well in their patient population because at the beginning of the intervention they identified a potential lack of awareness of the incoming FIT kit mailer as a barrier to uptake.

"We believe patients were receiving the kits with minimal advanced warning and discarding it as a mistake or hesitant to complete it because they did not understand the value to them," they told Medscape Medical News.

"Therefore, a priming message helped to bridge that gap and allowed patients to be aware of the incoming FIT kits, know why it was important to do the FIT kit, and ultimately led to increasing our FIT kit return rates and thus CRC screening," they said.

The researchers caution that their findings may be more relevant to patient populations who are more engaged in their health or who are more technologically savvy. In the UCLA Health system, roughly 84% of patients have an activated patient portal.

"Good Enhancement" for Healthcare Systems

Reached for comment, Aasma Shaukat, MD, MPH, professor of medicine, NYU Langone Health in New York City, and first author of the American College of Gastroenterology (ACG) 2021 CRC screening guidelines, said the results are "interesting but not entirely surprising."

"There's literature supporting that a letter or notification prior to the FIT being mailed improves its uptake. Here, the authors applied it to their healthcare system in a quality improvement study and demonstrated it works," Shaukat said.

"This is a good enhancement for healthcare systems where most of their patients are using or accessing their health chart portal," added Shaukat.

"Caveats are that the generalizability is not known. It requires EHR [electronic health record] support tools and patients with access to a computer and enrolled and able to access their electronic chart, likely those with high literacy and English speaking."

Funding for the study was provided by the U CLA Health Department of Medicine. Goshgarian, Croymans, and Shaukat have disclosed no relevant financial relationships.

JAMA Netw Open. Published online February 4, 2022. Full text

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