ABSTRACT
BACKGROUND
Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments.
OBJECTIVE
To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice.
DESIGN
Pragmatic randomized trial.
PARTICIPANTS
Men and women aged 50–74 years past due for CRC screen and women aged 40–74 years past due for BC screening.
INTERVENTIONS
We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call).
MAIN MEASURES
Documentation of mammography or colorectal cancer screening at 52 weeks following randomization.
KEY RESULTS
Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2–4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1–3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1–3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0–3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates.
CONCLUSIONS
The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.
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REFERENCES
Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(3):41–5.
Sabatino SA, Lawrence B, Elder R, et al. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med. 2012;43(1):97–118. doi:10.1016/j.amepre.2012.1004.1009.
Brouwers MC, De Vito C, Bahirathan L, et al. What implementation interventions increase cancer screening rates? A systematic review. Implement Sci. 2011;6:111. doi:10.1186/1748-5908-1186-1111.
Rodewald LE, Szilagyi PG, Humiston SG, Barth R, Kraus R, Raubertas RF. A randomized study of tracking with outreach and provider prompting to improve immunization coverage and primary care. Pediatrics. 1999;103(1):31–8.
Fiscella K, Humiston S, Hendren S, et al. A multimodal intervention to promote mammography and colorectal cancer screening in a safety-net practice. J Natl Med Assoc. 2011;103(8):762–8.
Fiscella K, Yosha A, Hendren SK, et al. Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice. BMC Health Serv Res. 2010;10:280. doi:10.1186/1472-6963-1110-1280.
Hendren S, Winters P, Humiston S, et al. Randomized controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice. JGIM. 2013. doi:10.1007/s11606-013-2506-1.
U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, American Community Survey, Census of Population and Housing, County Business Patterns, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report, Census of Governments 2012; http://quickfacts.census.gov/qfd/states/36/3663000.html. Accessed 7/27/2013.
Qaseem A, Denberg TD, Hopkins RH Jr, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–86.
Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60(2):99–119.
Sequist TD, Zaslavsky AM, Marshall R, Fletcher RH, Ayanian JZ. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2009;169(4):364–71. doi:10.1001/archinternmed.2008.1564.
Baron RC, Melillo S, Rimer BK, et al. Intervention to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers a systematic review of provider reminders. Am J Prev Med. 2010;38(1):110–7. doi:10.1016/j.amepre.2009.1009.1031.
Khankari K, Eder M, Osborn CY, et al. Improving colorectal cancer screening among the medically underserved: a pilot study within a federally qualified health center. J Gen Intern Med. 2007;22(10):1410–4.
Ling BS, Schoen RE, Trauth JM, et al. Physicians encouraging colorectal screening: a randomized controlled trial of enhanced office and patient management on compliance with colorectal cancer screening. Arch Intern Med. 2009;169(1):47–55.
Lasser KE, Murillo J, Lisboa S, et al. Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med. 2011;171(10):906–12.
Segnan N, Senore C, Andreoni B, et al. Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst. 2005;97(5):347–57.
Sequist TD, Zaslavsky AM, Colditz GA, Ayanian JZ. Electronic patient messages to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2011;171(7):636–41. doi:10.1001/archinternmed.2010.1467. Epub 2010 Dec 1013.
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97(6):1528–40.
Feldstein AC, Perrin N, Rosales AG, et al. Effect of a multimodal reminder program on repeat mammogram screening. Am J Prev Med. 2009;37(2):94–101.
Phillips CE, Rothstein JD, Beaver K, Sherman BJ, Freund KM, Battaglia TA. Patient navigation to increase mammography screening among inner city women. J Gen Intern Med. 2011;26(2):123–9.
Agency for Healthcare Research and Quality. Patient Centered Medical Home Resource Center. http://pcmh.ahrq.gov. Accessed 7/27/2013.
Dietrich AJ, Tobin JN, Cassells A, et al. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006;144(8):563–71.
Green BB, Wang CY, Anderson ML, et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial. Ann Intern Med. 2013;158(5 Pt 1):301–11. doi:10.7326/0003-4819-7158-7325-201303050-201300002.
Kempe KL, Shetterly SM, France EK, Levin TR. Automated phone and mail population outreach to promote colorectal cancer screening. Am J Manag Care. 2012;18(7):370–8.
Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2012;7, CD007458.
Hines P, Mercury M. Designing the role of the embedded care manager. Prof Case Manag. 2013;18(4):182–7.
Freeman HP. The history, principles, and future of patient navigation: commentary. Semin Oncol Nurs. 2013;29(2):72–5.
Ishikawa Y, Hirai K, Saito H, et al. Cost-effectiveness of a tailored intervention designed to increase breast cancer screening among a non-adherent population: a randomized controlled trial. BMC Publ Health. 2012;12:760. doi:10.1186/1471-2458-1112-1760.
Lee JK, Groessl EJ, Ganiats TG, Ho SB. Cost-effectiveness of a mailed educational reminder to increase colorectal cancer screening. BMC Gastroenterol. 2011;11:93. doi:10.1186/1471-1230X-1111-1193.
Misra S, Lairson DR, Chan W, et al. Cost effectiveness of interventions to promote screening for colorectal cancer: a randomized trial. J Prev Med Public Health. 2011;44(3):101–10. doi:10.3961/jpmph.2011.3944.3963.3101.
Saywell RM Jr, Champion VL, Skinner CS, Menon U, Daggy J. A cost-effectiveness comparison of three tailored interventions to increase mammography screening. J Womens Health (Larchmt). 2004;13(8):909–18.
Sequist TD, Franz C, Ayanian JZ. Cost-effectiveness of patient mailings to promote colorectal cancer screening. Med Care. 2010;48(6):553–7. doi:10.1097/MLR.1090b1013e3181dbd1098eb.
Smith DH, Feldstein AC, Perrin N, et al. Automated telephone calls to enhance colorectal cancer screening: economic analysis. Am J Manag Care. 2012;18(11):691–9.
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All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline.
Grant Support
This project was supported by the American Cancer Society - RSGT-08-077-01-CPHPS.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Fortuna, R.J., Idris, A., Winters, P. et al. Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening. J GEN INTERN MED 29, 90–97 (2014). https://doi.org/10.1007/s11606-013-2586-y
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DOI: https://doi.org/10.1007/s11606-013-2586-y