Take-home kits, automated calls, perfect FIT for increasing CRC scanning rates

A recent study conducted by researchers at the University of Colorado Cancer Center found that signed, sealed and delivered fecal immunochemical tests (FIT) can do wonders for colorectal cancer (CRC) screening rates.

Common knowledge decries the cost-effectiveness and life-retention properties intrinsic in CRC screening, yet only 65 percent of U.S. adults between ages 50 and 75 sought to undergo the highly recommended procedure in 2010. Provoked by such poor turnouts, Cancer Center scientists established a new systematic approach to augmenting CRC screening involvement — instituting a movement less grassroots and more down-home, do-it-yourself.

Prefaced by introductory phone calls, approximately 58,800 FITs were mailed to low-risk Kaiser members who were due for a CRC screening. Recipients could either complete the stool test from the comfort of their own home and mail it back or request a colonoscopy through their provider. Of the 58,800 patients contacted, 26,003 completed the screening via the FIT kit or a colonoscopy; ultimately, screening rates jumped from 47 percent to 72 percent in three years as a result of the study.

Karin Kempe, MD, MPH, recent director of clinical prevention at Kaiser Permanente Colorado, a CU Cancer Center consortium partner and co-author of the study, commented on the principle success that the study’s more personalized outreach had on the Kaiser patient community.

“The main point was that colorectal cancer screening does lend itself to a population outreach approach,” she said.

She was quick to add that such an approach is not without its conditions.

“There are some important requirements for physician practices wishing to implement a similar program, including the ability to stratify the population by risk so that the correct test is offered (high risk patients need colonoscopy, low risk patients can be offered a choice), and so that results can be managed in a consistent and systematic way. In particular, all positive FIT tests require colonoscopy.”

Whereas the CU Cancer Center took to the automatic telephoning of target males for screenings (as the subject pool was considerably robust) Kempe did not disregard smaller practice implementation of the new approach — even if that means electing the longhand method over punching the number pad.  

“While we used an automated call and mailed kits, it is also possible for smaller practices to offer screening by letter, requesting the patient to call in to request that a FIT test be ordered and mailed to them, or for a colonoscopy referral.”

Call or coquette, the correspondence should edify patients about the benefits of undergoing a CRC screening. Kempe noted that patients were grateful for the knowledge they gained from the calls especially.

“The phone calls offered useful educational information; we found that lack of knowledge was the most important barrier to screening,” she said.

Although education was imperative to securing more screenings, the ease and privacy offered in the home FIT kit format was also a pivotal proponent of CRC screening improvement in the study.

“Probably the main driver of improvement was the ease of screening in the home and then returning the mailed kit,” Kempe said. “It was interesting that over time, more patients eventually migrate into a colonoscopy program rather than repeating FIT testing each year. Patients do appreciate a choice of modality.” 

“There are many examples of home based management improving compliance particularly in the arena of chronic care, examples would be management of hypertension, or diabetes,” Kempe divulged when prompted about the FIT take-home model transpiring into other sectors of patient care.  

Granted “continued effort and investment in this area is definitely required,” it seems as though the FIT-mobile model developed by Kempe and her colleagues fits nicely into the healthcare mold for all practices, small and large.  

The study can be found here in The American Journal of Managed Care.

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