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Randomized Controlled Trial
. 2014 Jan;23(1):134-43.
doi: 10.1158/1055-9965.EPI-13-0795. Epub 2013 Nov 5.

Strategies to improve repeat fecal occult blood testing cancer screening

Terry C Davis  1 , Connie L Arnold, Charles L Bennett, Michael S Wolf, Cristalyn Reynolds, Dachao Liu, Alfred Rademaker
Affiliations
Randomized Controlled Trial

Strategies to improve repeat fecal occult blood testing cancer screening

Terry C Davis et al. Cancer Epidemiol Biomarkers Prev. 2014 Jan.

Abstract

Background: A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing.

Methods: Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in eight community clinics in Louisiana. Clinics were randomly assigned to receive: enhanced care, a screening recommendation, and FOBT kit annually; a brief educational intervention where patients additionally received a literacy appropriate pamphlet and simplified FOBT instructions; or nurse support where a nurse manager provided the education and followed up with phone support. In year 2, all materials were mailed. The study consisted of 461 patients, ages 50 to 85 years, with a negative initial FOBT.

Results: Repeat FOBT rates were 38% enhanced care, 33% education, and 59% with nurse support (P = 0.017). After adjusting for age, race, gender, and literacy, patients receiving nurse support were 1.46 times more likely to complete repeat FOBT screening than those receiving education [95% confidence interval (CI), 1.14-1.06; P = 0.002] and 1.45 times more likely than those in enhanced care but this was not significant (95% CI, 0.93-2.26; P = 0.10). The incremental cost per additional person screened was $2,450 for nurse over enhanced care.

Conclusion: A mailed pamphlet and FOBT with simplified instructions did not improve annual screening.

Impact: Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT, yet this may be too costly for community clinics.

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Conflict of interest statement

No conflicts are noted by the authors related to the work described.

Figures

Figure 1
Figure 1
Flowchart of Initial and Repeat Screening
Figure 2
Figure 2
Health Literacy Intervention Flow Chart
See this image and copyright information in PMC

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