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C-A3-01: The Effect of an Automated Reminder Call Intervention on Completion of Fecal Occult Blood Testing (FOBT)

Background: Colorectal cancer (CRC) is the third most common cancer in the United States and is associated with significant morbidity and mortality. Although CRC has a good prognosis if diagnosed early, screening rates remain low. Innovative, low cost intervention, such as the use of automated reminder calls, may increase CRC screening rates. The objective of this prospective study was to determine the effect of an automated telephone reminder message on completion of a fecal occult blood test (FOBT), an evidence-based screening method for populations with average risk for CRC. Methods: A prospective randomized clinical trial of 5,993 patients (intervention group = 2,993, usual care group = 3,000), between ages 51–80, due for CRC screening with average risk for CRC. The patient population received care in a not for profit HMO in the Pacific Northwest. The intervention group received a 1-minute automated telephone call, which provided a general description and health benefits of FOBT. Patients could request that an FOBT kit be mailed to their home on the call. Up to three calls were attempted for non respondents over a five month period. Multiple logistic regressions was used to examine the independent effect of automated reminder calls on completion of an FOBT test, after adjusting for age, gender and prior CRC screening. Results: Compared to usual care, those in the intervention group were significantly more likely to complete an FOBT (OR = 1.60, 95% CI = 1.39–1.84), five months post randomization. Two characteristics were also associated with completion of FOBT: older age [age 61–70 (OR = 1.33, 95% CI = 1.14–1.56), age 71–80 (OR = 1.85, 95% CI = 1.52–2.25] vs. age 51–60, and any prior CRC screening (OR = 3.13, 95% CI = 2.71–3.62) vs. no prior screening. Conclusions: Automated telephone calls increased completion of screening FOBT compared to usual care. Broad implementation may cost effectively increase community CRC screening rates. Further research is needed to better understand how the stage at CRC diagnosis and CRC related mortality are impacted and to evaluate cost effectiveness.