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Telling GPs which patients haven’t had CRC screening improves uptake

Outreach and notification to patients and GPs both improved screening completion rates

Louise Prime

Wednesday, 06 September 2017

Outreach and notification to patients and doctors both improved colorectal cancer (CRC) screening among patients who were not up-to-date or non-adherent with CRC screening, research published in JAMA has shown.

In the first study,* researchers assessed whether providing GPs from 801 practices in France with a list of their patients who were non-adherent to CRC screening improved patient participation in faecal immunochemical testing (FIT); they pointed out that this is a major challenge in countries that have implemented CRC screening programmes, and the screenings based on sigmoidoscopy or faecal tests are associated with a decreased 10-year mortality rate.

Their study included men and women aged 50-74 years who were at average risk of CRC and not up-to-date with CRC screening. The researchers randomly assigned GPs to one of three 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).

The researchers reported that at one year, 24.8% of patients in the specific reminders group, 21.7% in the generic reminders group, and 20.6% in the usual care group participated in the FIT screening. The between-group differences were 3.1% for the patient-specific reminders group vs the generic reminders group; 4.2% for the patient-specific reminders vs the usual care group; and 1.1% (which was not statistically significant) for the generic reminders vs the usual care group.

The researchers commented: “Providing GPs with a list of patients who were non-adherent to CRC screening was associated with a modest increase in FIT participation compared with providing GPs with generic reminders about regional CRC screening rates or providing no reminders.”

The other study** compared the effectiveness of faecal immunochemical test (FIT) outreach and colonoscopy outreach in increasing completion of the CRC screening process (screening initiation and follow-up) within three years.

In this study, patients aged 50-64 years who were not up-to-date with CRC screenings were randomly assigned to mailed FIT outreach (n=2,400), mailed colonoscopy outreach (n=2,400), or usual care with clinic-based screening (n=1,199).

The researchers reported that screening process completion within three years was 38.4% in the colonoscopy outreach group, compared with 28% in the FIT outreach group and 10.7% in the usual care group – compared with the usual care group, between-group differences for completion were higher for both outreach groups, and highest in the colonoscopy outreach group. Furthermore, compared with usual care, the between-group differences in adenoma and advanced neoplasia detection rates were higher for both outreach groups, and highest in the colonoscopy outreach group.

But the study authors pointed out that “screening process completion for both outreach groups remained below 40%, highlighting the potential for further improvement”.

They concluded: “These data can help clinicians weigh the pros and cons of different CRC screening strategies in their patient population and practice environment. It is important to consider patients’ barriers to screening initiation when recommending colonoscopy and the need for annual screening or diagnostic colonoscopy when recommending FIT.”

* Rat C, Pogu C, Le Donné D, et al. Effect of physician notification regarding nonadherence to colorectal cancer screening on patient participation in fecal immunochemical test cancer screening. A randomized clinical trial. JAMA 2017;318(9): 816–824. doi:10.1001/jama.2017.11387.

** Singal AG, Gupta S, Skinner CS, et al. Effect of colonoscopy outreach vs fecal immunochemical test outreach on colorectal cancer screening completion. A randomized clinical trial. JAMA 2017; 318(9):806–815. doi:10.1001/jama.2017.11389.

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