Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania.
Clin Gastroenterol Hepatol. 2024 Oct;22(10):2117-2124.e2. doi: 10.1016/j.cgh.2024.04.003. Epub 2024 Apr 30.
BACKGROUND & AIMS: Mailed outreach for colorectal cancer (CRC) screening increases uptake but it is unclear how to offer the choice of testing. We evaluated if the active choice between colonoscopy and fecal immunochemical test (FIT), or FIT alone, increased response compared with colonoscopy alone.
This pragmatic, randomized, controlled trial at a community health center included patients between ages 50 and 74 who were not up to date with CRC screening. Patients were randomized 1:1:1 to the following: (1) colonoscopy only, (2) active choice of colonoscopy or FIT, or (3) FIT only. Patients received an outreach letter with instructions for testing (colonoscopy referral and/or an enclosed FIT kit), a reminder letter at 2 months, and another reminder at 3 to 5 months via text message or automated voice recording. The primary outcome was CRC screening completion within 6 months.
Among 738 patients in the final analysis, the mean age was 58.7 years (SD, 6.2 y); 48.6% were insured by Medicaid and 24.3% were insured by Medicare; and 71.7% were White, 16.9% were Black, and 7.3% were Hispanic/Latino. At 6 months, 5.6% (95% CI, 2.8-8.5) completed screening in the colonoscopy-only arm, 12.8% (95% CI, 8.6-17.0) in the active-choice arm, and 11.3% (95% CI, 7.4-15.3) in the FIT-only arm. Compared with colonoscopy only, there was a significant increase in screening in active choice (absolute difference, 7.1%; 95% CI, 2.0-12.2; P = .006) and FIT only (absolute difference, 5.7%; 95% CI, 0.8-10.6; P = .02).
Both choice of testing and FIT alone increased response and may align with patient preferences.
clinicaltrials.gov NCT04711473.
邮寄结直肠癌（CRC）筛查外展服务可提高筛查参与率，但目前尚不清楚如何提供检测选择。我们评估了与单独进行结肠镜检查相比，主动选择结肠镜检查和粪便免疫化学检测（FIT）或仅进行 FIT 是否会增加响应率。
这项在社区卫生中心开展的实用、随机、对照试验纳入了年龄在 50 至 74 岁之间且未进行 CRC 筛查的患者。患者按 1:1:1 的比例随机分配至以下三组：（1）仅结肠镜检查；（2）主动选择结肠镜检查或 FIT，或（3）仅 FIT。患者收到了一封带有检测说明的外展信（结肠镜检查转诊和/或随附的 FIT 试剂盒），2 个月时收到提醒信，3 至 5 个月时通过短信或自动语音记录进行再次提醒。主要结局是在 6 个月内完成 CRC 筛查。
在最终分析的 738 例患者中，平均年龄为 58.7 岁（标准差，6.2 岁）；48.6%有医疗保险，24.3%有医疗保险；71.7%为白人，16.9%为黑人，7.3%为西班牙裔/拉丁裔。在 6 个月时，结肠镜检查组中有 5.6%（95%CI，2.8-8.5）完成了筛查，主动选择组中有 12.8%（95%CI，8.6-17.0），FIT 组中有 11.3%（95%CI，7.4-15.3）。与单独结肠镜检查相比，主动选择检测（绝对差异，7.1%；95%CI，2.0-12.2；P =.006）和仅 FIT（绝对差异，5.7%；95%CI，0.8-10.6；P =.02）的筛查率均显著增加。
检测选择和仅 FIT 均可提高响应率，并且可能符合患者的偏好。
clinicaltrials.gov NCT04711473。
