EFFECTIVENESS OF OPT-IN VERSUS OPT-OUT TEXT MESSAGE-BASED OUTREACH FOR COLORECTAL CANCER SCREENING

ABSTRACT

Background and Aims: Reliance on in-visit, opt-in screening for colorectal cancer (CRC) may be an obstacle to screening, especially during the COVID-19 pandemic and among low income and vulnerable populations. We aim to describe and evaluate the effectiveness of a CRC screening outreach campaign in a safety-net health system testing opt-out and opt-in text message outreach followed by mailed fecal immunochemical test (FIT) kits. Methods: From November 2020 to April 2021, the outreach campaign targeted patients ages 50-75 from 11 primary care clinics within the San Francisco Health Network who had previously completed a FIT test and were overdue for CRC screening. Patients were assigned to receive a language-concordant, pre-alert text message notifying that they would be mailed a FIT kit 1) unless they opted out of receiving a kit or 2) if they opted in to receiving a kit. The primary outcome was screening participation at 3 months after outreach. Results: A total of 371 patients were assigned to receive opt-out text messages and 522 received opt-in text messages. FIT kits were mailed to 96.5% (n = 358) of the opt-out group and 19.3% (n = 101) of the opt-in group. Screening uptake at 3 months was significantly higher in the optout group than in the opt-in group (58.8% vs. 18.0%, P < 0.001;difference = 40.8%, 95% confidence interval 34.8%-46.8%). Black/African American patients had lower screening rates (33.3% in opt-out group and 9.4% in opt-in group) compared to Hispanic/Latino (53.3% in opt-out group and 26.7% in opt-in group) and Asian (66.7% in opt-out group and 26.7% in opt-in group) patients. Conclusions: During the COVID-19 pandemic, optout text messaging followed by mailed FIT kits improved population-level CRC screening rates in a safety-net health system. Tailored initiatives are needed to address low screening rates for Black/African American patients.