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Evaluation of a Home‐Based Colorectal Cancer Screening Intervention in a Rural State

Charlton, Mary E., Mengeling, Michelle A., Halfdanarson, Thorvardur R., Makki, Nader M., Malhotra, Ashish, Klutts, J. Stacey, Levy, Barcey T., Kaboli, Peter J.
Journal of rural health 2014 v.30 no.3 pp. 322-332
colonoscopy, colorectal neoplasms, educational materials, health services, hematologic tests, patients, risk, rural areas, rural population, screening, surveys, veterans
PURPOSE: Distance from health care facilities can be a barrier to colorectal cancer (CRC) screening, especially for colonoscopy. Alternatively, an improved at‐home stool‐based screening tool, the fecal immunochemical test (FIT), requires only a single sample and has a better sensitivity‐specificity balance compared to traditional guaiac fecal occult blood tests. Our objective was to determine if FITs mailed to asymptomatic, average‐risk patients overdue for screening resulted in higher screening rates versus mailing educational materials alone or no intervention (ie, usual care). METHODS: Veterans ages 51‐64, asymptomatic, at average risk for CRC, overdue for screening and in a veterans administration (VA) catchment area covering a large rural population were randomly assigned to 3 groups: (1) education only (Ed) group: mailed CRC educational materials and a survey of screening history and preferences (N = 499); (2) FIT group: mailed the FIT, plus educational materials and survey (N = 500); and (3) usual care (UC) group: received no mailings (N = 500). FINDINGS: At 6 months postintervention, 21% of the FIT group had received CRC screening by any method compared to 6% of the Ed group (and 6% of the UC group) (P < .0001). Of the 105 respondents from the FIT group, 71 (68%) were eligible to take the FIT. Of those, 64 (90%) completed the FIT and 8 (12%) tested positive. CONCLUSIONS: This low‐intensity intervention of mailing FITs to average risk patients overdue for screening resulted in a significantly higher screening rate than educational materials alone or usual care, and may be of particular interest in rural areas.