Abstract
BackgroundFecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation.ObjectiveThe objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result.MethodsThis randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude.ResultsOverall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001).ConclusionsA text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests.Trial RegistrationClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl)
Highlights
Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world
Of 609 patients randomly selected from the patient database, 94 (15.4%) were excluded from the study sample: 46 (7.6%) because of family history of colorectal cancer (CRC), 22 (3.6%) because of an oncology diagnosis, and 26 (4.3%) because they had undergone colonoscopy prior to the positive fecal occult blood test (FOBT) result
2 patients in the control group died during the study period and 43 (9.1%) in the intervention group refused to receive an short message service (SMS) text message after their initial approval or were unable to receive SMS text message they had agreed to receive it
Summary
Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world It is the second most common malignant disease [1,2], with 90% survival when it is identified early and immediate surgical intervention is performed. A patient with positive FOBT result requires immediate follow-up with colonoscopy, and surgery should be performed when CRC is detected. Recommendations regarding the time between a positive result and colonoscopy vary across countries, ranging between 30 and 180 days [8,9,10,11,12,13]. Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. A large proportion of patients with a positive result do not follow this recommendation
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