Reminders linked to sizable increase in cancer screening rates

Patients who receive mailed information and phone calls about colorectal cancer tests are more likely to get them.

By Carolyne Krupa — Posted Nov. 21, 2012

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Interventions aimed at guiding patients and helping them better understand colorectal cancer screening can significantly boost screening rates, says a study published online Nov. 1 in Cancer Epidemiology Biomarkers and Prevention.

Researchers examined two types of interventions, including mailed materials and phone calls, and found that patients who received those services were about three times as likely to undergo screening than those who had neither.

Colorectal cancer is the third-leading cause of cancer-related deaths in the U.S. There will be an estimated 103,170 new cases of the disease and 51,690 related deaths in 2012, according to the American Cancer Society.

For the study, 945 patients ages 50 to 79 participated in the randomized, controlled trial. Of those, 312 received a tailored navigation intervention in which they were asked whether they would prefer undergoing a colonoscopy or taking a stool blood test. Based on their preference, those patients were mailed either information about getting a colonoscopy or kits to administer the blood test at home. They then received follow-up phone calls to guide them in scheduling a colonoscopy or administering the blood test.

An additional 316 patients were mailed the kit and information about both types of tests, and 317 patients received neither intervention, the study said (link).

Thirty-eight percent of patients who received the tailored navigation services and 33% of patients who received mailed materials completed screening tests, compared with 12% of patients in the control group.

“Both interventions increased screening significantly,” said Ronald E. Myers, PhD, lead study author, professor and director of the Division of Population Science in the Dept. of Medical Oncology at Thomas Jefferson University in Philadelphia.

Fewer choices, less confusion

The patients who received navigation services were steered to one of two tests on the hypothesis that narrowing choices would lead to much higher screening rates, Myers said.

“We found that giving people a menu of four or five different options seemed to add to the confusion,” he said. “One of the consequences of the confusion about all of the options was lower screening rates.”

Overall screening was strongest among intervention patients who opted for the stool blood tests compared with control patients, and weaker for those who opted for a colonoscopy, the study said.

“The rates were different because people found it just too difficult to get through the system to do the colonoscopy,” Myers said.

However, researchers said, narrowing options resulted in only a slightly higher screening rate than those who got mailings without specific guidance.

The Affordable Care Act requires health plans to cover certain colorectal cancer screening tests, including fecal blood tests and colonoscopies, with no out-of-pocket costs to patients, according to the American Cancer Society.

For the study, the patient navigators weren’t authorized to make colonoscopy appointments, only to instruct patients on what they needed to do to schedule them. Myers said he thinks more patients would have followed through and received colonoscopies if they had that extra help.

For health systems, the study shows that a phone-based navigation approach can help patients, Myers said.

“You wouldn’t have to have navigators in every office. You could have a more centralized approach,” he said. “By doing that in the right way, we can achieve greater screening rates and greater screening equity.”

Physicians can help increase screenings by educating their patients about the different tests available and giving them a choice, Myers said.

“For individual physicians, I think it’s important to recognize that patients have preferences for screening options. And I think it’s important that practices make tests available that patients are more likely to do, rather than taking a one-size-fits-all approach,” he said.

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