短信和邮件外拨在结直肠癌筛查中的应用：一项随机临床试验。
Text Messaging and Opt-out Mailed Outreach in Colorectal Cancer Screening: a Randomized Clinical Trial.
机构信息
Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
The Commonwealth Fund, Harkness Fellowship, New York City, NY, USA.
出版信息
J Gen Intern Med. 2021 Jul;36(7):1958-1964. doi: 10.1007/s11606-020-06415-8. Epub 2021 Jan 28.
BACKGROUND
Routine screening reduces colorectal cancer mortality, but screening rates fall below national targets and are particularly low in underserved populations.
OBJECTIVE
To compare the effectiveness of a single text message outreach to serial text messaging and mailed fecal home test kits on colorectal cancer screening rates.
DESIGN
A two-armed randomized clinical trial.
PARTICIPANTS
An urban community health center in Philadelphia. Adults aged 50-74 who were due for colorectal cancer screening had at least one visit to the practice in the previously year, and had a cell phone number recorded.
INTERVENTIONS
Participants were randomized (1:1 ratio). Individuals in the control arm were sent a simple text message reminder as per usual practice. Those in the intervention arm were sent a pre-alert text message offering the options to opt-out of receiving a mailed fecal immunochemical test (FIT) kit, followed by up to three behaviorally informed text message reminders.
MAIN MEASURES
The primary outcome was participation in colorectal cancer screening at 12 weeks. The secondary outcome was the FIT kit return rate at 12 weeks.
KEY RESULTS
Four hundred forty participants were included. The mean age was 57.4 years (SD ± 6.1). 63.4% were women, 87.7% were Black, 19.1% were uninsured, and 49.6% were Medicaid beneficiaries. At 12 weeks, there was an absolute 17.3 percentage point increase in colorectal cancer screening in the intervention arm (19.6%), compared to the control arm (2.3%, p < 0.001). There was an absolute 17.7 percentage point increase in FIT kit return in the intervention arm (19.1%) compared to the control arm (1.4%, p < 0.001).
CONCLUSIONS
Serial text messaging with opt-out mailed FIT kit outreach can substantially improve colorectal cancer screening rates in an underserved population.
TRIAL REGISTRATION
clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03479645 ).
背景
常规筛查可降低结直肠癌死亡率，但筛查率低于国家目标，在服务不足的人群中尤其低。
目的
比较单次短信外展与连续短信和邮寄粪便家庭检测试剂盒对结直肠癌筛查率的影响。
设计
一项双臂随机临床试验。
参与者
费城的一家城市社区卫生中心。年龄在 50-74 岁之间的成年人，在之前的一年中至少有一次就诊于该诊所，并且记录了手机号码。
干预措施
参与者被随机分配（1:1 比例）。对照组仅按常规发送简单的短信提醒。干预组先发送预提醒短信，提供选择退出邮寄粪便免疫化学检测（FIT）试剂盒的选项，然后最多发送三条行为告知短信提醒。
主要测量指标
主要结局是在 12 周时参与结直肠癌筛查。次要结局是在 12 周时 FIT 试剂盒的返回率。
主要结果
共纳入 440 名参与者。平均年龄为 57.4 岁（标准差±6.1）。63.4%为女性，87.7%为黑人，19.1%无保险，49.6%为医疗补助受益人。在 12 周时，干预组的结直肠癌筛查率绝对增加了 17.3 个百分点（19.6%），而对照组仅增加了 2.3%（p<0.001）。干预组的 FIT 试剂盒返回率绝对增加了 17.7 个百分点（19.1%），而对照组仅增加了 1.4%（p<0.001）。
结论
带有选择退出邮寄 FIT 试剂盒的连续短信外展可以显著提高服务不足人群的结直肠癌筛查率。
试验注册
clinicaltrials.gov（https://clinicaltrials.gov/ct2/show/NCT03479645）。
Zotero 插件