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J Gen Intern Med. 2018 Jan;33(1):72-78. doi: 10.1007/s11606-017-4184-x. Epub 2017 Oct 10.

Effect of Reminding Patients to Complete Fecal Immunochemical Testing: A Comparative Effectiveness Study of Automated and Live Approaches.

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Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Sea Mar Community Health Centers, Seattle, WA, USA.



The Community Preventive Services Task Force recommends multi-component interventions, including patient reminders, to improve uptake of colorectal cancer screening.


We sought to compare the effectiveness of different forms of reminders for a direct-mail fecal immunochemical test (FIT) program.


Patient-randomized controlled trial.


2772 adults aged 50-75, not up to date with colorectal cancer screening recommendations, with a clinic visit in the previous year at any of four participating health center clinics.


Participants were mailed an introductory letter and FIT. Those who did not complete their FIT within 3 weeks were randomized to receive (1) a reminder letter, (2) two automated phone calls, (3) two text messages, (4) a live phone call, (5) a reminder letter and a live phone call, (6) two automated phone calls and a live phone call, or (7) two text messages and a live phone call. Patients with a patient portal account were sent two email reminders, but were not randomized.


FIT return rates for each group, 6 months following randomization.


A total of 255 (10%) participants returned their FIT within 3 weeks of the mailing. Among randomized participants (n = 2010), an additional 25.5% returned their FITs after reminders were delivered (estimated overall return rate = 32.7%). In intention-to-treat analysis, compared to the group allocated to receive a reminder letter, return rates were higher for the group assigned to receive the live phone call (OR = 1.51 [1.03-2.21]) and lower for the group assigned to receive text messages (OR = 0.66 [0.43-0.99]). Reminder effectiveness differed by language preference.


Our data suggest that FIT reminders that included a live call were more effective than reminders that relied solely on written communication (a text message or letter).



automated and live reminders; colorectal cancer screening; direct-mail program; fecal testing; federally qualified health centers

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