Reducing Colorectal Cancer Death Through Mailed Outreach Screening

VA Office of Research and Development

Status: Completed

Conditions: Colorectal Cancer

Treatments: Other: Mailed-FIT; Other: Screening invitation-reminder

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT02584998

01522 (Other Identifier)

PPO 14-369

Details and patient eligibility

About

The main study aim is to develop, implement and disseminate a pilot population-based mailed FIT outreach screening program in the Philadelphia VA Medical Center that does not rely on having an office visit, by conducting a proof-of-concept 3-arm parallel-design pragmatic randomized trial to (1) Compare the effects of usual care (UC), screening invitation + reminder (invitation-reminder), or screening invitation + mailed FIT kit + reminder (mailed-FIT); (2) Explore whether the FIT completion rate varies by age or race/ethnicity; and (3) Explore barriers to use of mailed outreach screening for Veterans.

Full description

This study seeks to establish the foundation to systematically study and improve the delivery and effectiveness of colorectal cancer (CRC) screening in the VA by developing, implementing and disseminating a pilot mailed-FIT screening outreach program that does not rely on having a clinical office visit. The investigators specifically address the need to identify and remediate potential failures to identify and offer screening to eligible Veterans through multilevel interventions. The investigators will also create electronic data linkages to, in future studies, enable evaluation of FIT performance characteristics and help close critical evidence gaps for optimizing screening among Veterans. As this is a pilot study, the focus is to assess feasibility of a population-based screening outreach approach through the development, implementation and dissemination of a mailed FIT outreach program in the Philadelphia VA Medical Center that does not rely on having an office visit.

Enrollment: 782 patients

Sex: All

Ages: 50 to 74 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• The pragmatic trial will include Veterans in southeastern Pennsylvania and Southern New Jersey who, during the funding year
• 50 to 75 years old
• Have received care at the Philadelphia VA Medical Center in the 18-48 months prior to selection for the study but who have not been seen by primary care in the past 18 months prior to selection
• Due for screening
• Are asymptomatic for CRC
• This includes the period during which 3-sample testing was being regularly used at the Philadelphia VA Medical Center

Exclusion criteria

• Have any known gastrointestinal symptoms such as:

  • bleeding
  • unexplained weight loss
  • change in bowel habits
  • family history of CRC
  • inflammatory bowel disease (IBD)
  • colectomy using International Classification of Disease (9th and 10th edition) diagnostic code or by self-report.

• The investigators will also exclude Veterans:

  • with evidence of prior colonoscopy within 10 years
  • sigmoidoscopy within 5 years
  • fecal occult blood test (FOBT)/FIT in the same calendar year

• The information used to exclude patients will be derived from the electronic queries or chart audits.

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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782 participants in 3 patient groups

Usual care

No Intervention group

Description:

These patients will continue to receive the current practice at the Philadelphia VA Medical Center (VAMC) of offering screening during an office visit. Other interventions will be embedded within this existing program for a pragmatic approach. However, all participants in the trial, including those in usual care (UC), will receive follow-up of test results and navigation to diagnostic colonoscopy for positive FIT results.

Screening invitation-reminder

Active Comparator group

Description:

Participants will receive UC and also receive an invitation letter with information about CRC testing. The information will include lay-audience description of screening tests and symptoms that should prompt diagnostic work-up. The packet will have instructions to contact the study team if participants believe they are not eligible and to update the contact information on record. The letter will inform participants that a telephone reminder will follow in 4 weeks from invitation letter if screening is not completed. They will also receive notification of test results and navigation to colonoscopy, if needed. For the purposes of this intervention, Week 1 will be the week the invitation letter was sent (time zero).

Treatment:

Other: Screening invitation-reminder

Mailed-FIT

Active Comparator group

Description:

Participants randomized to Mailed-FIT will receive a mailed FIT pre-notification letter (plus a screening invitation) followed by the kit 1 week later. Participants will receive instructions to contact the study team if they believe they are not eligible and to update their contact information. They will be informed that a telephone reminder will follow 4 weeks from notification letter if screening is not completed. Participants who do not return their kit within 4 weeks after their pre-notification letter was mailed will receive a live telephone reminder, followed by 2 additional calls at the end of weeks 5 and 6, if needed. For the purposes of this intervention, Week 1 will be the week the pre-notification letter was sent (time zero).

Treatment:

Other: Mailed-FIT