Automated telephone calls improved completion of fecal occult blood testing

Abstract

Background: Although colorectal cancer (CRC) prognosis is improved by early diagnosis, screening rates remain low.

Objective: To determine the effect of an automated telephone intervention on completion of fecal occult blood testing (FOBT).

Research design: In this randomized controlled trial conducted at Kaiser Permanente Northwest, a not-for-profit health maintenance organization, 5905 eligible patients aged 51 to 80, at average risk for CRC and due for CRC screening, were randomly assigned to an automated telephone intervention (n = 2943) or usual care (UC; n = 2962). The intervention group received up to three 1-minute automated telephone calls that provided a description and health benefits of FOBT. During the call, patients could request that an FOBT kit be mailed to their home. Those who requested but did not return the cards received an automated reminder call. Cox proportional hazard method was used to determine the independent effect of automated telephone calls on completion of an FOBT, after adjusting for age, sex, and prior CRC screening.

Results: By 6 months after call initiation, 22.5% in the intervention and 16.0% in UC had completed an FOBT. Those in the intervention group were significantly more likely to complete an FOBT (hazard ratio, 1.31; 95% confidence interval, 1.10-1.56) compared with UC. Older patients (aged 71-80 vs. aged 51-60) were also more likely to complete FOBT (hazard ratio, 1.48; 95% confidence interval, 1.07-2.04).

Conclusions: Automated telephone calls increased completion of FOBT. Further research is needed to evaluate automated telephone interventions among diverse populations and in other clinical settings.

Figure 1

Study design and population selection* *Eligible patients were due for routine CRC screening (and in whom stool occult blood testing was a clinically appropriate option) and who met other criteria detailed below: ¹Those due for CRC screening that have NOT had any of the following: 1) colonoscopy within 10 years, 2) flexible sigmoidoscopy of DCBE within 5 years, 3) FOBT screening within past 12 months, or 4) order for FOBT/DCBE in past 3 months. ²Remove population with: 1) active colon cancer/risk factors that would indicate need for disease monitoring, diagnostic testing or non-routine screening frequency defined as: GI referral for chronic diarrhea, esophageal reflux, iron deficiency, polyp follow-up or rectal surgery in past 12 months, 2) ever diagnosed with adenomatous polyps or HIV/AIDS or 3) referred for colonoscopy or sigmoidoscopy in last 3 months ³Remove population at risk for a false positive stool occult blood test due to receipt of plavix or warfarin medications in past 4 months. ⁴Remove population where screening not indicated due to patient with total colectomy; in hospice care; or with ESRD. ⁵Had continuous enrollment in HMO, 24 months prior to randomization.

Figure 2

Kaplan-Meier Curve: Time to Completion of FOBT1 ¹ p < .001. Log-Rank Test used to assess statistical significance.