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OPTIMIZATION OF A PROGRAMMATIC MAILED FECAL IMMUNOCHEMICAL TEST INITIATIVE FOR COLORECTAL CANCER SCREENING IN THE ERA OF COVID-19
Gastroenterology ; 162(7):S-281, 2022.
Article in English | EMBASE | ID: covidwho-1967271
ABSTRACT
Introduction The COVID-19 pandemic led to a sharp decrease in colorectal cancer screening rates as all non-urgent procedures, including average-risk screening colonoscopies, were suspended for infection control and resource conservation. In response to pandemic restrictions, many organizations have turned to alternative strategies such as fecal immunochemical test (FIT) outreach programs. Though prior randomized controlled trials have demonstrated success of mailed programmatic stool test initiatives, there are few studies examining specific strategies for delivering such programs. Methods Baseline pre-intervention FIT completion data was obtained between March 2020 and July 2020 at the Providence VA Medical Center. We then implemented a programmatic mailed FIT initiative at a single community-based outpatient clinic between February 2021 and August 2021 by 1) identifying all patients due for average risk colorectal cancer screening through a VA database, 2) sending primer letters and a brief survey to confirm average risk, 3) mailing FIT kits and 4) sending reminder letters 4 weeks after mailed FIT kits. The primary endpoint was overall FIT completion rate. Secondary endpoints included survey response rate, completed FIT after initial mailing and reminder letter, positive FIT rate, and rate of colonoscopy completion for positive FIT. Results Baseline FIT completion rate prior to the intervention was 29.8% (148/497). A total of 378 patients were identified through the database as being due for average risk colorectal cancer screening and were sent primer letters with surveys. 36.5% (138/378) of patients responded to the survey and 23.3% of those who responded (32/138) were found to be at increased risk and were removed from the FIT mailing list. 36.9% (126/347) of patients completed their FIT within 4 weeks of initial kit mailing. An additional 6.7% (15/221) returned their FIT after a reminder letter. The overall FIT completion rate after our interventions was 40.6% (141/347) which was a statistically significant improvement compared with the pre-intervention group (p=0.0012 using Fisher's exact test). 8.5% (12/141) of patients who completed their FIT had a positive result. Of these patients, 58.3% (7/12) had documented colonoscopy completion within 6 months of positive FIT and 41.6% (5/12) either declined the procedure or were unresponsive to scheduling attempts. Conclusion Programmatic mailed FIT outreach is an effective strategy to enhance colorectal cancer screening. Primer and reminder letters are a simple yet effective steps for improving mailed FIT completion rates. Further studies are needed to validate these methods to optimize averagerisk colorectal cancer screening, particularly in the era of COVID-19 where colonoscopy capability is limited at many centers. (Figure Presented)
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Gastroenterology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Gastroenterology Year: 2022 Document Type: Article