Implementing systems change to improve colorectal cancer screening among clinics providing care for underserved Hispanic populations

Abstract

Background: Colorectal cancer (CRC) is the most common cause of cancer-related deaths in Hispanics in the U.S. Hispanics are screened for CRC at a much lower rate. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention to increase CRC screening rates in vulnerable populations. We aim to describe the effect of using introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US-Mexico border county. Methods: This was a prospective pragmatic two-arm intervention study with participants randomized to receive a FIT kit by mail or a FIT kit mailed with an introductory call. The primary outcome was the percentage of patients who returned the FIT kit. Results: Participants who returned the FIT were primarily unemployed (51.1%), had less than a high school education(51.8%), had lived in the U.S. for at least 20 years (71.2%), and had poor self-reported health(48.9%). In addition, we observed a statistically significant absolue rate increase (6.1%, P = 0.003) in CRC screening return rates when a mailed FIT kit was preceded by an introductory compared to no initial call. Conclusion: This study demonstrates that adding an introductory phone call significantly improves the screening completion rate in a mailed-out CRC screening intervention in a US-Mexico border population.