Randomized, controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice

J Gen Intern Med. 2014 Jan;29(1):41-9. doi: 10.1007/s11606-013-2506-1. Epub 2013 Jul 2.


Background: Cancer screening rates are suboptimal for low-income patients.

Objective: To assess an intervention to increase cancer screening among patients in a safety-net primary care practice.

Design: Patients at an inner-city family practice who were overdue for cancer screening were randomized to intervention or usual care. Screening rates at 1 year were compared using the chi-square test, and multivariable analysis was performed to adjust for patient factors.

Subjects: All average-risk patients at an inner-city family practice overdue for mammography or colorectal cancer (CRC) screening. Patients' ages were 40 to 74 years (mean 53.9, SD 8.7) including 40.8 % African Americans, 4.2 % Latinos, 23.2 % with Medicaid and 10.9 % without any form of insurance.

Intervention: The 6-month intervention to promote cancer screening included letters, automated phone calls, prompts and a mailed Fecal Immunochemical Testing (FIT) Kit.

Main measures: Rates of cancer screening at 1 year.

Key results: Three hundred sixty-six patients overdue for screening were randomly assigned to intervention (n = 185) or usual care (n = 181). Primary analysis revealed significantly higher rates of cancer screening in intervention subjects: 29.7 % vs. 16.7 % for mammography (p = 0.034) and 37.7 % vs. 16.7 % for CRC screening (p = 0.0002). In the intervention group, 20 % of mammography screenings and 9.3 % of CRC screenings occurred at the early assessment, while the remainder occurred after repeated interventions. Within the CRC intervention group 44 % of screened patients used the mailed FIT kit. On multivariable analysis the CRC screening rates remained significantly higher in the intervention group, while the breast cancer screening rates were not statistically different.

Conclusions: A multimodal intervention significantly increased CRC screening rates among patients in a safety-net primary care practice. These results suggest that relatively inexpensive letters and automated calls can be combined for a larger effect. Results also suggest that mailed screening kits may be a promising way to increase average-risk CRC screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnostic imaging
  • Colorectal Neoplasms / diagnosis
  • Correspondence as Topic
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Health Promotion / organization & administration
  • Healthcare Disparities
  • Humans
  • Male
  • Mammography / statistics & numerical data
  • Middle Aged
  • New York
  • Patient Acceptance of Health Care / statistics & numerical data
  • Primary Health Care / organization & administration*
  • Socioeconomic Factors
  • Telephone
  • Urban Health Services / organization & administration