Coronado Gloria D, Nyongesa Denis B, Escaron Anne L, Petrik Amanda F, Thompson Jamie H, Smith Dave, Davis Melinda M, Schneider Jennifer L, Rivelli Jennifer S, Laguna Tanya, Leo Michael C
Kaiser Permanente Center for Health Research, Portland, Oregon.
AltaMed Health Services, Corporation, Los Angeles, California.
Cancer Epidemiol Biomarkers Prev. 2023 Nov 1;32(11):1608-1616. doi: 10.1158/1055-9965.EPI-23-0597.
Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer screening rates, yet little is known about how to optimize these programs for effectiveness and cost.
PROMPT was a pragmatic, stepped-wedge, cluster-randomized effectiveness trial of mailed FIT outreach. Participants in the standard condition were mailed a FIT and received live telephone reminders to return it. Participants in the enhanced condition also received a tailored advance notification (text message or live phone call) and two automated phone call reminders. The primary outcome was 6-month FIT completion; secondary outcomes were any colorectal cancer screening completion at 6 months, implementation, and program costs.
The study included 27,585 participants (80% ages 50-64, 82% Hispanic/Latino; 68% preferred Spanish). A higher proportion of enhanced participants completed FIT at 6 months than standard participants, both in intention-to-treat [+2.8%, 95% confidence interval (CI; 0.4-5.2)] and per-protocol [limited to individuals who were reached; +16.9%, 95% CI (12.3-20.3)] analyses. Text messages and automated calls were successfully delivered to 91% to 100% of participants. The per-patient cost for standard mailed FIT was $10.84. The enhanced program's text message plus automated call reminder cost an additional $0.66; live phone calls plus an automated call reminder cost an additional $10.82 per patient.
Adding advance notifications and automated calls to a standard mailed FIT program boosted 6-month FIT completion rates at a small additional per-patient cost.
Enhancements to mailed FIT outreach can improve colorectal cancer screening participation. Future research might test the addition of educational video messaging for screening-naïve adults.
邮寄粪便免疫化学检测（FIT）推广可提高结直肠癌筛查率，但对于如何优化这些项目以提高有效性和控制成本却知之甚少。
PROMPT是一项关于邮寄FIT推广的务实、阶梯式楔形、整群随机有效性试验。标准组的参与者收到一份FIT检测，并收到电话提醒以返还检测样本。强化组的参与者还会收到定制的提前通知（短信或电话）以及两次自动电话提醒。主要结局是6个月时FIT检测的完成情况；次要结局是6个月时任何结直肠癌筛查的完成情况、实施情况及项目成本。
该研究纳入了27585名参与者（80%年龄在50 - 64岁，82%为西班牙裔/拉丁裔；68%更喜欢西班牙语）。在意向性分析[+2.8%，95%置信区间（CI；0.4 - 5.2）]和符合方案分析[仅限于被联系到的个体；+16.9%，95%CI（12.3 - 20.3）]中，强化组在6个月时完成FIT检测的参与者比例均高于标准组。短信和自动电话成功发送给了91%至100%的参与者。标准邮寄FIT检测的人均成本为10.84美元。强化项目中短信加自动电话提醒的成本每人额外增加0.66美元；电话加自动电话提醒的成本每人额外增加10.82美元。
在标准的邮寄FIT项目中增加提前通知和自动电话，以少量的人均额外成本提高了6个月时FIT检测的完成率。
对邮寄FIT推广的改进可提高结直肠癌筛查的参与度。未来的研究可以测试为未进行过筛查的成年人添加教育视频信息的效果。
