Adherence to colorectal cancer screening with multi-target stool DNA testing among first-time average-risk users in federally qualified health centers

Abstract

Introduction: Federally Qualified Health Centers (FQHC) provide healthcare services to nearly 30 million people across the United States. Despite this critical role, substantial gaps in colorectal cancer (CRC) screening persist in FQHC populations compared to the general U.S. population. This study evaluated the adherence to multi-target stool DNA (mt-sDNA) screening among average-risk patients undergoing their first CRC screening at FQHCs.

Methods: Patients aged 45-75 years that received care at FQHC clinics and had a valid mt-sDNA test kit shipped between January 1 and December 31, 2023, were included. Patient adherence was defined as the completion and return of the test kit, with a valid test result obtained within 365 days of the initial shipment date. Logistic regression analysis was performed to determine patient characteristics associated with adherence.

Results: A total of 264,465 patients had a mt-sDNA test kit shipped to them during the study period. The overall adherence to screening was 55.9%, with an average of 37 days from initial shipment date to valid test result. Predictors associated with increased adherence included being commercially insured, having lower social vulnerability scores, older age, female sex, digital patient outreach, living outside a metropolitan area, and living in a ZIP code with higher median household income.

Conclusion: The current study found that the adherence to mt-sDNA testing in a patient population receiving care at FQHCs was higher than previously reported. This research highlighted several important predictors of improved adherence to mt-sDNA testing, including digital patient outreach as an inexpensive and increasingly utilized tool to enhance CRC screening adherence.

Keywords: FQHC; Federally qualified health center; adherence; cancer screening; colon cancer; colorectal cancer screening; mt-sDNA.