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Research ArticleResearch Letter

Veterans' Continued Participation in an Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening

Jennifer A. Schlichting, Michelle A. Mengeling, Nader M. Makki, Ashish Malhotra, Thorvardur R. Halfdanarson, J. Stacey Klutts, Barcey T. Levy, Peter J. Kaboli and Mary E. Charlton
The Journal of the American Board of Family Medicine July 2015, 28 (4) 494-497; DOI: https://doi.org/10.3122/jabfm.2015.04.140241
Jennifer A. Schlichting
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
PhD
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Michelle A. Mengeling
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
PhD
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Nader M. Makki
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD
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Ashish Malhotra
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD
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Thorvardur R. Halfdanarson
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD
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J. Stacey Klutts
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD, PhD
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Barcey T. Levy
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD, PhD
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Peter J. Kaboli
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
MD, MS
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Mary E. Charlton
From the VA Office of Rural Health, Rural Health Resource Center, Central Region, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center and Pathology and Laboratory Medicine (JSK), Iowa City VA Healthcare System, Iowa City, IA (JAS, MAM, AM, PJK, MEC); the Department of Epidemiology, University of Iowa College of Public Health, Iowa City (JAS, BTL, MEC); the Division of General Internal Medicine, Department of Internal Medicine (MAM, NMM, PJK), the Department of Pathology (JSK), and the Department of Family Medicine (BTL), University of Iowa Carver College of Medicine, Iowa City; and the Division of Oncology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ (TRH).
RN, PhD
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    Figure 1.

    Study population, Iowa City VA Health Care System. *Percentage calculated from the total eligible to participate. Of 204 invited to participate, 45 were ineligible (2 moved out of the area, 1 was deceased, 17 self-reported scheduled colonoscopy or otherwise being up to date on screening, and 25 reported new symptoms and/or family history on the eligibility questionnaire given before the survey). This left 159 potentially eligible to participate. Three were unable to be contacted and 24 declined participation, but were included in these 159 potentially eligible patients. FIT, fecal immunochemical testing.

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    Table 1. Survey Participant Characteristics and Responses, Iowa City VA Health Care System (n = 132)
    Characteristics/Preferences, 2012 to 2013Participants
    Age in years (mean, SD)62 (4)
    Male sex122 (92)
    Rural area of residence78 (59)
    Good/very good/excellent general health95 (72)
    Race
        White123 (93)
        Black6 (5)
        Other3 (2)
    Health insurance in addition to VHA benefits (could report >1)
        Private individual or group plan34 (26)
        Military17 (13)
        Medicaid8 (6)
        Medicare31 (23)
        VHA benefits only65 (49)
    Highest education more than some college or technical school74 (56)
    Have at least 1 child (≤18 years) living in household17 (13)
    More than 1 adult (>18 years) living in household89 (67)
    Currently married/partnered77 (58)
    Participant has someone who can bring to health care appointments if needed121 (92)
    Has an additional non-VA primary care provider30 (23)
    Health care provider has previously recommended a colonoscopy95 (72)
    Ever had a colonoscopy60 (45)
    Ever had colonoscopy performed at a VA facility12 (20)
    Who should make the decision for when you should be screened for colon cancer?*
        You alone or mostly you21 (16)
        The doctor and you equally77 (58)
        Mostly the doctor or the doctor alone33 (25)
    Who should make the decision for which test should be used for screening?*
        You alone or mostly you37 (28)
        The doctor and you equally35 (26)
        Mostly the doctor or the doctor alone59 (45)
    More likely to take colonoscopy every 10 years or FIT every year?
        FIT88 (67)
        Colonoscopy11 (8)
        No preference32 (24)
        Prefer not to be screened1 (1)
    Preferred method to receive CRC screening due reminders (could report >1)
        Mail110 (83)
        Phone55 (42)
        E-mail30 (23)
        At clinic visit40 (30)
        No reminder1 (1)
    Preferred method to receive FIT kit
        Mail120 (91)
        Pick up at nearest VA facility1 (1)
        No preference11 (8)
    FIT satisfaction (answered “extremely” or “very”)
        How easy was it for you to follow the FIT kit directions?117 (89)
        How convenient was the FIT kit for you?118 (89)
        If the FIT was mailed to you each year, how likely would you be to complete it each year?128 (97)
    • Data are n (%) unless otherwise indicated.

    • ↵* One missing response.

    • CRC, colorectal cancer; FIT, fecal immunochemical testing; SD, standard deviation; VHA, Veterans Health Administration.

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The Journal of the American Board of Family     Medicine: 28 (4)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 4
July-August 2015
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Veterans' Continued Participation in an Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening
Jennifer A. Schlichting, Michelle A. Mengeling, Nader M. Makki, Ashish Malhotra, Thorvardur R. Halfdanarson, J. Stacey Klutts, Barcey T. Levy, Peter J. Kaboli, Mary E. Charlton
The Journal of the American Board of Family Medicine Jul 2015, 28 (4) 494-497; DOI: 10.3122/jabfm.2015.04.140241

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Veterans' Continued Participation in an Annual Fecal Immunochemical Test Mailing Program for Colorectal Cancer Screening
Jennifer A. Schlichting, Michelle A. Mengeling, Nader M. Makki, Ashish Malhotra, Thorvardur R. Halfdanarson, J. Stacey Klutts, Barcey T. Levy, Peter J. Kaboli, Mary E. Charlton
The Journal of the American Board of Family Medicine Jul 2015, 28 (4) 494-497; DOI: 10.3122/jabfm.2015.04.140241
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