Offering more testing options fails to boost CRC screening rates

  • Mehta SJ & al.
  • JAMA Netw Open
  • 2 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A choice between scheduling a colonoscopy and fecal immunochemical testing (FIT) led to no change in colorectal cancer (CRC) screening completion.
  • Colonoscopy popularity fell as FIT kits became more readily available.

Why this matters

  • Offering colonoscopy alone may imply that it is the default option.

Study design

  • Randomized controlled trial (n=438; 55.0% women).
  • Participants received mailed outreach about CRC screening. Participants were randomly assigned to direct phone number to call for scheduling colonoscopy (colonoscopy only), direct phone number to call for colonoscopy plus a mailed FIT kit if they did not respond within 4 weeks (sequential choice), or both colonoscopy phone number and a mailed FIT kit (active choice).
  • Funding: NIH.

Key results

  • Median patient age, 56 years (range, 50-74 years; interquartile range, 52-63 years).
  • After 4 months, there was no statistically significant difference in CRC screening completion between the colonoscopy-only arm (14.4%), the sequential choice arm (17.1%), and the active choice arm (19.9%). There was also no significant difference at 6 months.
  • Of those who completed CRC screening by 4 months, the colonoscopy rate was highest in the colonoscopy arm (90.5%; 95% CI, 78.0%-103.0%), followed by the sequential choice arm (52.0%; P=.005) and the active choice arm (37.9%; P<.001>

Limitations

  • No mailed FIT-only arm.