ORIGINAL RESEARCH
Sean P. McClellan, MD; Shreya Patel, MD; Elizabeth Uy-Smith, MD; Blake Gregory, MD; John M. Neuhaus, PhD; Michael B. Potter, MD; Ma Somsouk, MD
Corresponding Author: Sean P. McClellan, MD; Department of Family and Community Medicine, University of Illinois at Chicago
Email: smccle2@uic.edu
DOI: 10.3122/jabfm.2023.230399R1
Keywords: Colorectal Cancer, Delivery of Health Care, Early Detection of Cancer, Gastroenterology, Health Services, Linear Regression, Middle Aged, Preventive Medicine, Primary Health Care, Quantitative Research, Safety-Net Providers, Screening
Dates: Submitted: 11-01-2023; Revised: 02-24-2024; Accepted: 03-04-2024
FINAL PUBLICATION: |HTML| |PDF|
PURPOSE: Colorectal cancer (CRC) screening is recommended starting at age 45, but there has been little research on strategies to promote screening among patients younger than 50. This study assessed the effect of a multicomponent intervention on screening completion in this age group.
METHODS: The intervention consisted of outreach to patients aged 45-49 (n = 3,873) via mailed fecal immunochemical test (FIT) (sent to 46%), text (84%), email (53%), and the extension to this age group of an existing standing order protocol allowing primary care nurses and medical assistants to order FIT at primary care clinics in an urban safety-net system. We used segmented linear regression to assess changes in CRC screening completion trends. Patients aged 51-55 were included as a comparison group (n = 3,943). Data were extracted from the EHR.
RESULTS: The percentage of patients aged 45-49 who were up-to-date with CRC screening (colonoscopy in 10 years or FIT in last year) increased an average of 0.4% (95% CI 0.3, 0.6) every 30 days prior to intervention rollout and 2.8% (95% CI 2.5, 3.1) after (slope difference 2.3% [95% CI 2.0, 2.7]). This difference persisted after accounting for small changes in the outcome observed in the comparison group (slope difference 1.7% [95% CI 1.2, 2.2]).
CONCLUSIONS: These results suggest that the intervention increased CRC screening completion among patients 45-49. Healthcare systems seeking to improve CRC screening participation among patients aged 45-49 should consider implementing similar interventions