Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial

Abstract

Importance: Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs.

Objective: To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT).

Design, setting, and participants: A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016.

Interventions: General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients).

Main outcomes and measures: The primary end point was patient participation in CRC screening 1 year after the intervention.

Results: Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group.

Conclusions and relevance: Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care.

Trial registration: clinicaltrials.gov Identifier: NCT02515344.

Figure.. Participant Flow for Enrollment and Allocation to the Study Groups

^aThe numbers of general practitioners (GPs) excluded for each specific reason are not available. ^bMedical reasons for exclusion were personal history (colorectal cancer [CRC] or adenoma larger than 1 cm, mutation of the HNPCC gene, inflammatory bowel diseases), 14.4%; family history (CRC or adenoma larger than 1 cm), 17.4%; recent colonoscopy performed in the context of symptoms, 64.1%; and other reasons, 4.1%. The numbers of patients excluded for each specific reason in each group are not available. ^cAdministrative reasons for exclusion were moved to another geographical area, 84.6%; deceased, 3.7%; and other reasons, 11.7%. The numbers of patients excluded for each specific reason in each group are not available.