Improving persistent adherence to colorectal cancer screening in primary care by telephone reminders and SMS: a randomized controlled trial
Although persistent adherence is a key success factor of organized colorectal cancer (CRC) screening programme, it is common to observe decreasing adherence over time in primary care. Few studies compared the effectiveness of different reminder services on enhancing adherence to CRC screening programmes. We aimed to evaluate whether delivering interactive telephone reminders or SMS messages could increase persistent adherence to annual fecal immunochemical test (FIT) when compared with usual care.
A large cohort of CRC screening participants who joined a community-based screening programme in Hong Kong was recruited in 2015. Asymptomatic subjects aged 40-70 years with negative FIT results in the first screening round in 2015 were eligible. These participants were requested to participate in their second round of FIT in the same month of their first screening round. We randomly assigned each eligible participant to one of the following three groups: (1). An interactive telephone reminder by healthcare professionals; (2). receiving a short message service (SMS) ; or (3). Usual care (i.e. no reminders). All participants were blinded to the outcomes before they received the intervention. A University ethics committee waived consent of the study participants. The primary outcomes included the pick-up rate of FIT tubes and the rate of successful return of properly completed FIT specimen in the second year. We used chi-square tests and binary logistic regression analyses to compare outcomes among the three groups.
We recruited 630 screening subjects and their baseline characteristics were similar (Table 1). For the telephone, SMS and usual care groups, the pick-up rate of FIT was 88.5%, 77.4% and 61.4%, respectively (p<0.001). The corresponding proportion of subjects who attended late for FIT tube pick up was 3.4%, 6.6% and 10.5%p=0.016); whilst the corresponding specimen return rate was 89.9%, 81.6%, and 68.1% (p<0.001). When compared with the control group, participants in the SMS group and telephone reminder group were significantly more likely to pick up FIT tubes (Adjusted Odds Ratio [AOR]: 2.40, 95% C.I. 1.52, 3.80, p<0.001; AOR: 5.97, 95% C.I. 3.46, 10.3, p<0.001) and return completed FIT specimens (AOR: 2.42, 95% C.I. 1.48, 3.95, p<0.001; AOR: 5.16, 95% C.I. 2.90, 9.16, p<0.001), after controlling for subjects’ age, gender, socioeconomic status and concomitant comorbidities (Table 2). Significantly more subjects in the telephone reminder group achieved either outcomes as compared to the SMS group (AOR=2.55, 95% C.I. 1.44, 4.53, p=0.001; AOR=2.19, 95% C.I. 1.19, 4.02, p=0.012).
Interactive telephone reminders, and to a lesser extent SMS messages were found to be effective in increasing adherence rate of FIT screening in community-based CRC screening programmes. The cost-effectiveness of these reminder strategies will need to be further examined in future studies.