Mailed Participant Reminders Are Associated With Improved Colonoscopy Uptake After a Positive FOBT Result in Ontario's ColonCancerCheck Program

Implement Sci. 2015 Mar 13;10:35. doi: 10.1186/s13012-015-0226-0.

Abstract

Background: Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. This study evaluates the effectiveness of two ongoing interventions designed to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario's population-wide ColonCancerCheck program. The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonoscopy. The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up.

Methods: Prospective cohort study using Ontario's ColonCancerCheck program data sets (2008-2011), linked to provincial administrative health databases. Crude rate ratios were calculated to assess determinants of colonoscopy uptake among an Ontario-wide FOBT-positive cohort with rolling enrolment, followed from October 2008 through February 2011. Segmented time-series regression was used to assess the average additional change in colonoscopy uptake after FOBT-positive status following the introduction of two ongoing interventions among the same cohort.

Results: A notification mailed directly to FOBT-positive screening participants was observed to increase colonoscopy uptake, beyond the modest average underlying increase throughout the study period, by an average of 3% per month (multivariable-adjusted RR: 1.03, 95% CI: 1.00-1.06). However, revision of the existing FOBT result notification to physicians was observed to have no effect.

Conclusions: Direct participant notification of a positive FOBT result improved adherence with follow-up colonoscopy in Ontario's population-wide ColonCancerCheck program. Further participant-directed interventions may be effective means of maximizing adherence in population-wide screening.

MeSH terms

  • Aged
  • Colonic Neoplasms / diagnosis*
  • Colonic Neoplasms / psychology
  • Colonoscopy / psychology
  • Colonoscopy / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Occult Blood*
  • Ontario
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Postal Service* / methods
  • Prospective Studies
  • Reminder Systems*