Mailed FIT, patient navigation increased CRC screening in rural Medicaid enrollees
A program that mailed fecal immunochemical tests (FITs) to Medicaid enrollees and implemented patient navigation to colonoscopies after an abnormal result increased colorectal cancer screening participation at six months by 7.3 percentage points compared with usual care, according to a multicenter trial.
Mailed fecal immunochemical test (FIT) outreach and patient navigation increased participation in colorectal cancer (CRC) screening by rural Medicaid enrollees, a clinical trial found.
Researchers randomized 28 rural clinics in Oregon to the intervention or to usual care. All patient participants (n=5,614; average age, 58.2 years) were enrolled in Medicaid and due for CRC screening between May 2021 and June 2022. The primary outcome was completion of CRC screening within six months of eligibility, with an additional effectiveness outcome of follow-up colonoscopy within six months of an abnormal FIT result. The study population was 52.5% female, 6.2% Hispanic, 67.2% White, and 79.4% rural. Findings were published by JAMA Network Open on March 17.
Participants at intervention clinics (n=2,613) had a higher adjusted six-month proportion of any CRC screening compared with those in usual care clinics (n=3,001) (11.8% vs. 4.5%; difference, 7.3 percentage points [95% CI, 5.3 to 9.2 percentage points]; P<0.001). All of the 1,489 intervention-eligible enrollees were mailed a FIT, 88.5% were sent at least one advance notification, and 78.1% were sent at least one reminder. Of those with an abnormal FIT, 57.9% received some patient navigation for follow-up colonoscopy.
At 12 months, the intervention group had higher rates of any CRC screening (16.8% vs. 9.0%) and FIT (11.5% vs. 4.5%). Of the 34 enrollees with abnormal FIT results, 43.3% in intervention clinics completed a follow-up colonoscopy within six months, compared to 15.4% in usual care clinics, a difference of 27.9 percentage points (95% CI, 1.2 to 54.6 percentage points).
One limitation to the study is the possibility that claims data did not capture all screening events, especially among patients who disenrolled in Medicaid.
Overall, the findings “add to a growing body of literature on the effectiveness of mailed FIT outreach and underscore the continued need to address low participation in follow-up colonoscopy among individuals with abnormal stool-test results,” the study authors wrote.
An accompanying editorial highlighted the trial's successful employment of an “effective combination of known, evidence-based interventions for CRC screening outreach in a feasible, multilevel program in a clinical setting for a population that would be an ideal target for interventions to increase screening uptake.” However, the editorialists noted the need for more research on increasing screening rates, as just 12% of participants who received a mailed FIT kit returned the test and 43% of patients with a positive result completed a colonoscopy.