Article Figures & Data
Figures
- Figure 1.
Flow of patients through the colorectal cancer screening trial. IRENE, Iowa Research Network; FIT, fecal immunochemical test.
- Figure 2.
Colorectal cancer screening (CRC) reminder.
- Figure 3.
Iowans Get Screened magnet.
- Figure 4.
A: Cumulative percentage screened with any method by study group. B: Cumulative percentage screened with fecal immunochemical test (FIT) or colonoscopy (CS) by study group.
Tables
Variables Usual Care (n=185) Physician Chart Reminder (n=185) Mailed Education/FIT (n=186) Mailed Education + Phone Call (n=187) Age (years) <65 136 (73.5) 131 (70.8) 131 (70.4) 136 (72.7) ≥65 49 (26.5) 54 (29.2) 55 (29.6) 51 (27.3) Female sex 99 (53.5) 94 (50.8) 97 (52.2) 96 (51.3) Marital status Single 27 (14.6) 34 (18.4) 26 (14.0) 27 (14.4) Married 145 (78.4) 135 (73.0) 143 (76.9) 148 (79.1) Widowed 13 (7.0) 14 (7.6) 17 (9.1) 11 (5.9) Unknown 0 (0) 2 (1.1) 0 (0) 1 (0.5) Hispanic ethnicity 3 (1.6) 2 (1.1) 2 (1.1) 1 (0.5) Race White 182 (98.4) 182 (98.4) 183 (98.4) 186 (99.5) Black 2 (1.1) 0 (0) 2 (1.1) 0 (0) Asian 0 (0) 0 (0) 1 (0.5) 0 (0) Other/unknown 1 (0.5) 3 (1.6) 0 (0) 1 (0.5) Educational level High school or less 61 (33.0) 69 (37.3) 68 (36.6) 75 (40.1) Some college or more 123 (66.5) 112 (60.5) 117 (62.9) 111 (59.4) Unknown 1 (0.5) 4 (2.2) 1 (0.5) 1 (0.5) Uninsured 6 (3.2) 14 (7.6) 18 (9.7) 13 (7.0) Annual income ($) <40,000 72 (38.9) 61 (33.0) 69 (37.1) 71 (38.0) 40,000-<80,000 79 (42.7) 83 (44.9) 81 (43.5) 76 (40.6) ≥$80,000 23 (12.4) 24 (13.0) 26 (14.0) 31 (16.6) Unknown 11 (6.0) 17 (9.2) 10 (5.4) 9 (4.8) Rural resident 156 (84.3) 152 (82.2) 151 (81.2) 150 (80.2) Family history Immediate family member 13 (7.0) 19 (10.3) 22 (11.8) 24 (12.9) More distant relative 23 (12.4) 18 (9.7) 26 (14.0) 16 (8.6) Patient reported doctor had recommended CRC screening 91 (49.2) 84 (45.4) 101 (54.3) 97 (51.9) Mean barrier scores (SD) 1.4 (0.9) 1.4 (0.8) 1.3 (0.8) 1.3 (0.9) Subject rated CRC screening highly important (8–10 on scale of 1–10) 103 (55.7) 105 (56.8) 110 (59.1) 105 (56.1) ↵* Data are n (%) unless otherwise indicated. There were no significant differences for the variables in this table among the 4 groups.
CRC, colorectal cancer; FIT, fecal immunochemical test; SD, standard deviation.
Variables Usual Care (n=177) Physician Chart Reminder (n=173) Mailed Education/FIT (n=178) Mailed Education/FIT + Phone Call (n=176) Mean body mass index (SD) 31.1 (7.2) 31.5 (7.5) 30.2 (6.3) 30.6 (6.3) Visits (26 months before the initial mailing) 4 (2, 6) 4 (2, 7) 4 (2, 7) 4 (1, 7) Annual visits (26 months before prenotice date) 0 (0, 1) 0 (0, 1) 1 (0, 1) 1 (0, 1) Medical conditions 2 (1, 4) 3 (2, 4) 3 (2, 4) 3 (2, 4) Medications (prescription and over the counter) 5 (3, 8) 5 (2, 7) 6 (3, 9) 5 (3, 8) Any visit during the 15 month follow-up time period, n (%) 134 (75.7) 133 (76.9) 139 (78.1) 135 (76.7) Any visit in past 26 months, n (%) 158 (89.3) 150 (86.7) 157 (88.2) 151 (85.8) Annual exam visit in past 26 months, n (%) 80 (45.2) 83 (48.0) 93 (52.3) 91 (51.7) Cholesterol in past 5 years, n (%) 126 (71.2) 126 (72.8) 128 (71.9) 111 (63.1) Mammogram in past 26 months, (386 women), n (%) 50 (52.1) 38 (43.7) 51 (54.3) 41 (46.1) Bone density in past 26 months (88 women ≥65 years old), n (%) 5 (19.2) 4 (18.2) 3 (16.7) 5 (22.7) PSA level in past 26 months (357 men), n (%) 36 (44.4) 46 (53.5) 34 (40.5) 39 (44.8) Values are median (25th percentile, 75th percentile) unless otherwise indicated. There were no significant differences for the variables in this table among the 4 groups.
↵* Only 704 subjects had charts available for review. The total number of available charts was used as the denominator.
FIT, fecal immunochemical test; PSA, prostate-specific antigen; SD, standard deviation.
- Table 3. Comparisons of Primary and Secondary Outcomes, with Usual Care as Reference Group
Tests Completed Usual Care (n=185) Physician Chart Reminder (n=185) Mailed Education/FIT (n=186) Mailed Education/FIT + Phone Call (n=187) Overall P Any CRC test completed during the 15-month follow-up period n (%) 33 (17.8) 38 (20.5) 105 (56.5) 107 (57.2) <.0001 OR (95% CI) Reference 1.2 (0.7–2.0) 6.0 (3.7–9.6) 6.2 (3.8–9.9) Colonoscopy n (%) 22 (11.9) 33 (17.8) 41 (22.0) 36 (19.3) .073 OR (95% CI) Reference 1.6 (0.9–2.9) 2.1 (1.2–3.7) 1.8 (1.0–3.1) Take home fecal occult blood test (x3), n (%) 5 (2.7) 5 (2.7) 4 (2.2) 3 (1.6) .875 Flexible sigmoidoscopy, n (%) 1 (0.5) 0 (0) 0 (0) 0 (0) .389 Barium enema, n (%) 0 (0) 0 (0) 0 (0) 0 (0) FIT returned to investigators, n (%)* — — 84 (45.2) 91 (48.7) .498 ↵* No fecal immunochemical test (FIT) was mailed to the usual care or chart reminder groups.
CI, confidence interval; CRC, colorectal cancer; OR, odds ratio.
- Table 4. Predictors of Becoming Up To Date with Colorectal Cancer (CRC) Screening* Using Prespecified Covariables
Outcome variable (Any tests completed) Odds Ratio 95% CI P Intercept — — .008 Chart reminder vs usual care 1.23 0.71–2.11 .46 Mailed education/FIT vs usual care 6.29 3.80–10.43 <.0001 Mailed education/FIT + phone call vs usual care 6.38 3.86–10.54 <.0001 Sex (female vs male) 1.06 0.75–1.49 .76 Education (high school or less vs college) 1.00 0.70–1.42 .99 Insurance (yes vs no) 1.26 0.62–2.58 .53 Age (per 1-year increase) 1.01 0.98–1.03 .57 Family history of CRC (immediate or distant) 1.45 0.95–2.20 .08 Patient reported doctor had recommended CRC screening (yes vs no) 1.66 1.16–2.37 .006 Importance of CRC screening to your health† 1.76 1.23–2.52 .002 Baseline average barrier score‡ 0.84 0.67–1.03 .10 Had a physical exam visit during follow-up (yes vs. no) 1.48 1.03–2.11 .03 ↵* With the SAS Glimmix procedure, which controls for the clustering of patients within practices.
↵† Scores of 8–10 vs 1–7, with higher numbers indicating more importance.
↵‡ Per an increase of 1 in average barrier score, the odds ratio was 0.84 given other variables remain constant in the model. (There were 13 questions about barriers, each of which was scored from 0–5, with higher scores indicating more barriers.)
CI, confidence interval; FIT, fecal immunochemical test.
