The effectiveness of volunteer-delivered vs. professional-delivered telephone reminders vs. Short Message Services on adherence to colorectal cancer screening: A randomised controlled trial

Problem

Background: Adherence to serial faecal immunochemical testing (FIT) as part of colorectal cancer (CRC) screening is crucial for programme success, yet decline in adherence over time is common. We compared the effectiveness of delivering interactive telephone reminders by a trained volunteer vs. healthcare professional vs. short message services (SMS) on improving persistent adherence to yearly FIT.

Approach

This is a randomised, parallel group, open-label trial (2016-2017) in a primary care screening practice. We recruited 500 asymptomatic screening participants aged 40-70 years who joined a population-based screening programme in Hong Kong in 2016. Thy had negative FIT results in the first screening round (2016) who were invited to repeat their second round of FIT 12 months later (2017). Each subject was randomly assigned to receive an interactive telephone reminder delivered by a trained volunteer (n=250) or no additional reminders (n=250). The main outcome included FIT collection rate and the specimen return rate within one month after their expected return. Binary logistic regression analysis was used to evaluate the association between the intervention and the outcomes, controlling for age, gender, marital status, household income and educational level. We conducted a pooled analysis by including subjects who received telephone reminders delivered by healthcare professionals and SMS, respectively, from another randomised controlled trial (JAMA 2017;3:1281-1283).

Findings

The average age of the study participants was 56.5 years and 62.2% were male subjects. The cumulative rate of FIT collection was 223/246 (90.7%) and 147/248 (59.3%), respectively, for the volunteer-delivered telephone and control groups (p<0.001). The corresponding specimen return rate was 213/246 (86.6%) and 142/248 (57.3%) (p<0.001). Individuals in the volunteer-delivered telephone group were significantly more likely to collect FIT tubes (Adjusted Odds Ratio [AOR]: 7.75, 95% C.I. 4.61-13.0, p<0.001) and return completed specimens (AOR: 5.68, 95% C.I. 3·56-9·08, p<0.001). The higher adjusted odds in the telephone group remained significant in subgroup analysis. We also combined the findings of the present study with another randomized controlled trial (JAMA 2017;3:1281-1283). When compared with the control, the FIT collection and return rate were higher in individuals who received SMS (AOR=2.93, 95% C.I.=1.92-4.47 and AOR=2.98, 95% C.I.=1.97-4.50, respectively), volunteer-delivered telephone reminders (AOR=5.66, 95% C.I.=3.51-9.11; AOR=4.26, 95% C.I.=2.80-6.49) and professional-delivered telephone reminders (AOR=6.85, 95% C.I.=3.90-12.04; AOR=6.35, 95% C.I.=3.76-10.72) (all p<0.001). Compared with subjects who received SMS, study participants in both the volunteer-delivered and professional-delivered groups were more likely to collect FIT kits and return FIT specimens. Volunteer-delivered telephone calls were similarly effective as professional-delivered calls.

Consequences

Volunteer-delivered telephone reminders are highly effective in enhancing adherence with FIT-based screening programmes. Since this reminder strategy does not incur any direct cost, it represents an operationally practical, feasible and cost-effective strategy to enhance screening adherence.