Primer message increases colorectal cancer screening rates

Researchers have found a simple and inexpensive way to get more adults to take a fecal immunochemical test (FIT) to screen colorectal cancer (CRC).

In a randomized controlled trial, patients who received an ‘introductory’ email through their patient portal before the test kit arrived in their mailbox were more likely to complete and return the test than their peers who did not receive the e-mail message.

“We were thrilled by the magnitude of the impact,” said Gregory Goshgarian, MSc, MPH, and Daniel Croymans, MD, of the Department of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles. , in a joint e-mail addressed to Medscape Medical News.

At UCLA Health, “including an introductory message on the patient portal is now standard practice for our FIT messaging program,” they added.

Their study was published online today in Open JAMA Network.

Warning message drives compliance

CRC screening rates in the United States remain well below the national benchmark of 80%, and COVID-19 has not helped. As a result, several medical and professional societies have emphasized the use of a mail-in FIT outreach program.

As part of the outreach program, UCLA Health researchers developed an electronic introductory message in the electronic patient portal to alert patients scheduled for CRC screening that they would receive a FIT kit in the mail.

They tested the impact of primer messages in a randomized controlled trial involving 2339 adults (mean age, 59, 57.5% female). Of these, 1157 received the standard mailed FIT kit (control group) and 1182 received the standard mailed FIT kit along with an introductory message sent through their personal patient portal.

Adding the initiation message significantly increased the FIT completion rate at 6 months by 5.5%, with rates of 37.6% in the intervention group versus 32.1% in the a group of witnesses.

After adjusting for patient demographics, priming (compared to no priming) resulted in a significantly increased odds of completing CRC screening (adjusted odds ratio [OR]: 1.29; 95% CI, 1.08 – 1.53; P = 0.004).

The primer message also shortened the time to FIT screening by 3 days (35 days with the primer versus 38 days without).

Goshgarian and Croymans believe that priming messages worked well in their patient population because early in the intervention they identified a potential lack of awareness of sending the inbound FIT kit as a barrier to uptake. .

“We believe patients received the kits with minimal advance warning and discarded them as a mistake or were hesitant to complete them because they did not understand its value to them,” they said. Medscape Medical News.

“Therefore, a priming message helped bridge this gap and enabled patients to be aware of incoming FIT kits, to know why it was important to do the FIT kit, and ultimately led to increased rates. back from our FIT kits and therefore CRC screening.” they said.

The researchers warn that their findings may be more relevant to patient populations who are more committed to their health or who are more technologically savvy. In the UCLA healthcare system, approximately 84% of patients have a patient portal enabled.

“Good improvement” for health systems

Contacted for comment, Aasma Shaukat, MD, MPH, Professor of Medicine, NYU Langone Health in New York, and first author of the American College of Gastroenterology (ACG) 2021 CRC screening guidelinessaid the results are “interesting but not entirely surprising.”

“There is literature supporting that a letter or notification before sending the FIT improves its uptake. Here, the authors applied it to their healthcare system in a quality improvement study and demonstrated that it works,” Shaukat said.

“This is a good improvement for healthcare systems where most of their patients use or access their medical records portal,” Shaukat added.

“The caveats are that the generalizability is not known. This requires an EHR [electronic health record] support tools and patients with access to a computer and registered and able to access their electronic records, likely those with high literacy and English speaking. »

Funding for the study was provided by the U CLA Department of Health Medicine. Goshgarian, Croymans and Shaukat did not disclose any relevant financial relationship.

JAMA Netw Open. Published online February 4, 2022. Full Text

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