https://gastroenterology.acponline.org/archives/2025/07/25/5.htm

Spotlight on FIT outreach

One study found that patients were more likely to complete fecal immunochemical testing (FIT) with video versus pictorial instructions, while another offered a model for increasing follow-up of abnormal results.


Two recent studies reported on the results of mailed efforts to get patients to complete fecal immunochemical testing (FIT).

The first, published by the American Journal of Gastroenterology on July 7, was a study of an effort in the U.S. to improve response to mailed FIT outreach through an organized colorectal cancer (CRC) screening program. The 13,471 English-speaking patients and 508 Spanish-speaking patients were randomized to receive a FIT kit with either a QR-code-linked video or pictorial instructions in their preferred language. Overall, 31.9% completed the FIT. In both English- and Spanish-speaking patients, completion rate was higher with the QR-code instructions (33.5% vs. 30.4%; absolute difference, 3.1% [95% CI, 1.5% to 4.6%]). The median time to FIT completion was two days longer with the QR code than with pictures in English-speaking patients.

“Taken together, these findings suggest that offering low-health literacy instructions in multiple formats and languages may be one strategy to improve FIT completion in CRC screening programs,” said the study authors. They noted that potential challenges with a QR-code-based system, including some patients' limited comfort with technology or access to the internet, could be addressed by coupling QR-code-based videos with pictorial instructions.

The second study, published by the Journal of General Internal Medicine on July 14, was an observational study of patients eligible for CRC screening and covered by one health plan's value-based care programs (four Medicare, one Medicaid) in October 2023. FITs were mailed to the patients' homes from November to December 2023, and patients who didn't complete them were called three times three weeks after delivery. Of the 3,680 kits mailed, 94.2% were delivered, and 13.4% of those delivered were completed. The completion rate was higher in patients who had an appointment with a clinician within the previous 18 months (15.9% vs. 9.3%). A total of 45 patients had abnormal results (9.7%), and 11 of them (24.4%) completed diagnostic colonoscopies. All but one (90.0%) were found to have tubular adenomas.

The study authors concluded that the program increased CRC screening and provided an end-to-end process for increasing follow-up. “A registered nurse care manager to answer any concerns or questions, provide care coordinated with gastroenterologists for patients with abnormal results, and serve as a liaison between patients and the health system helped achieve these results,” they said. The authors also pointed out the potential utility of the finding that patients who have been seen more recently are more likely to complete testing. The timeframe for sending out tests could be based on this or FIT could be integrated into ambulatory visits, they suggested.