Direct-mail FOBT kits bridge colorectal screening gap
The mailing of fecal occult blood test (FOBT) kits to persons overdue for colorectal cancer screening proved to be an effective way to promote such screening among patients with high levels of poverty, limited English proficiency, and racial and ethnic diversity.
“Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened,” concluded the investigators who launched this randomized controlled trial in their report for Annals of Family Medicine (2012;10:412-417), a journal sponsored in part by the American Academy of Family Physicians (AAFP).
As noted in an AAFP statement accompanying the release of the findings, previous research has shown that direct-to-patient mailing of FOBT kits can lead to higher colorectal cancer screening rates in predominantly white, middle-class, or well-insured populations. This new study demonstrates that the same strategy can also significantly improve screening rates among economically disadvantaged patients from a wide range of racial, ethnic, and cultural backgrounds.
The study participants included adults aged 50 to 80 years who had made at least two visits to a specific community health center in the prior 18 months. Many of the patients served by the health center did not speak English; were Hispanic, African-American, or Asian; and were uninsured or had Medicaid. Records indicated that none of the men or women enrolled in the study were up-to-date with colorectal cancer screening by December 31, 2009.
Patients were assigned to the outreach intervention or to usual care. Those in the outreach group were mailed a fact sheet about colorectal cancer and an FOBT kit, and initial nonresponders received follow-up telephone calls. The usual-care group could be referred for screening during usual clinician visits.
In all, 30% of the 104 patients in the outreach group completed colorectal cancer screening within 4 months after initiation of the outreach protocol, compared with just 5% of the 98 usual-care members. Nearly all of the screenings were by FOBT. The two groups did not differ significantly in terms of the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test.
According to the AAFP, the results are especially important given the marked disparities in colorectal screening among racial and ethic minorities, persons born outside the United States, persons with lower income, and the uninsured.