Malani Kanika, Dayanim Gabriel, Ouellette Jennifer, Shittu Yetunde, Myers Theresetta, Elfanagely Yousef, Loscalzo Kirsten, Promrat Kittichai
Warren Alpert Medical School of Brown University.
Division of Gastroenterology, Providence Veterans Affairs Medical Center.
J Clin Gastroenterol. 2025 Jul 16. doi: 10.1097/MCG.0000000000002183.
This study aimed to (1) compare colorectal cancer (CRC) screening rates among patients receiving mailed fecal immunochemical testing (FIT) versus in-clinic FIT and (2) assess the impact of various reminder interventions versus no extra reminder on mailed FIT completion.
FIT is a first-line method for CRC screening. However, no research has compared screening completion in patients receiving FIT through mail (mailed FIT) versus patients receiving FIT from a provider in a clinic setting (in-clinic FIT), both of which have significantly different workflows. Furthermore, limited research has compared whether varying reminder strategies improve mailed FIT completion.
This quality improvement prospective cohort study conducted at the Providence Veterans Affairs Medical Center included patients due for average-risk CRC screening. Sixteen hundred patients were mailed FIT, and if FIT was not returned within 1 month they were randomized to the following reminders: no extra reminder, personal phone call, personal voicemail, mailed postcard. Simultaneously, 1769 patients received in-clinic FIT. Three-month return and result rates were compared between mailed versus in-clinic FIT, as well as across the different mailed FIT reminder interventions.
Mailed FIT return (36%) and result (34%) rates were significantly higher than in-clinic FIT return (28%) and result (24%) rates (both P<0.0001). Phone calls were the most effective mailed FIT reminder (29% return rate), significantly outperforming the no extra reminder group (21% return rate, P=0.02).
Mailed FIT demonstrated higher efficacy and should be implemented in conjunction with in-clinic FIT. Phone call reminders should be incorporated into the mailed FIT workflow.
本研究旨在（1）比较接受邮寄粪便免疫化学检测（FIT）的患者与门诊FIT患者的结直肠癌（CRC）筛查率，以及（2）评估各种提醒干预措施与无额外提醒对邮寄FIT完成情况的影响。
FIT是CRC筛查的一线方法。然而，尚无研究比较通过邮寄方式接受FIT的患者（邮寄FIT）与在门诊环境中从医疗服务提供者处接受FIT的患者（门诊FIT）的筛查完成情况，这两种方式的工作流程有显著差异。此外，比较不同提醒策略是否能提高邮寄FIT完成情况的研究有限。
这项在普罗维登斯退伍军人事务医疗中心进行的质量改进前瞻性队列研究纳入了应进行平均风险CRC筛查的患者。向1600名患者邮寄了FIT，如果在1个月内未返回FIT，则将他们随机分为以下提醒组：无额外提醒、个人电话、个人语音邮件、邮寄明信片。同时，1769名患者接受了门诊FIT。比较了邮寄FIT与门诊FIT之间以及不同邮寄FIT提醒干预措施之间的三个月返回率和结果率。
邮寄FIT的返回率（36%）和结果率（34%）显著高于门诊FIT的返回率（28%）和结果率（24%）（均P<0.0001）。电话是最有效的邮寄FIT提醒方式（返回率29%），显著优于无额外提醒组（返回率21%，P=0.02）。
邮寄FIT显示出更高的疗效，应与门诊FIT联合实施。电话提醒应纳入邮寄FIT工作流程。
