This paper looked at different strategies and tried to figure out which strategy would be most attractive to bring more people in for screening. This is a large, randomized controlled trial with good distribution of patient populations with approximately half female, half White, and a mean age around 48 years, with more than 20,000 patients.
One of four screening strategies was used. Patients were invited for a fecal immunochemical test, a colonoscopy, or they were invited to choose between a FIT test and a colonoscopy. The final group was mailed a FIT test kit as an outreach mechanism.
Invitations were sent via electronic patient portals, which are very common nowadays, and via the United States Postal Service. Text-message reminders were sent a couple of weeks later. The primary outcome of this study was to look at any colorectal cancer completion rate at 26 weeks.
The results of the study were quite interesting. Screening completion rates were relatively low at 18%. It was interesting to note that the highest screening rates were seen with those who had the FIT test mailed to them, whereas each of the other three groups that had only invitations sent to them had relatively lower screening compliance rates.
The lowest participation was in the colonoscopy invitation group, I suspect due to the invasive nature of the procedure and the patients’ perception of that. When patients were offered a choice, they were more likely to be compliant with screening. In the end, more patients chose colonoscopy as their screening test of choice compared with FIT testing.
The take-home point from this study is that directly sending test kits as an outreach might be more effective than simply inviting subjects to be screened. From those who do respond to be screened, more patients would choose colonoscopy, compared with the FIT test.
With that, I come to the end of this video capsule summary for the Best of GI for Primary Care from DDW 2023. We covered a variety of topics, ranging from pancreatitis to H pylori to colon cancer screening and a couple of GI surgical interventions with long-term outcomes that are very favorable.
Dr. Kaul disclosed conflicts of interest with AMBU, Cook Medical, CDS, CDX,Steris, and Motus GI.
A version of this article first appeared on Medscape.com.