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RTIPs Meet-up: Mailed Reminder To Increase Completion of Fecal Occult Blood Testing (FOBT) for Veterans

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We were delighted to add Mailed Reminder To Increase Completion of Fecal Occult Blood Testing (FOBT) for Veterans to the RTIPs repository this month!

"Mailed Reminder To Increase Completion of Fecal Occult Blood Testing (FOBT) for Veterans” is an intervention designed to increase colorectal cancer screening among men and women aged 50 years and older who are patients at a VA medical center primary care clinic. The intervention is intended to serve as a follow-up to usual care, which includes identifying primary care patients who are eligible for FOBT screening and providing them with FOBT kits (i.e., test card, instructions on how to complete the test, postage paid return envelope). The intervention involves mailing a personalized educational reminder to all patients 10 days after they receive the FOBT kit. Written at an eighth-grade reading level, the mailer consists of four components: a reminder to return the FOBT card, a few facts about CRC and CRC screening (e.g., risks of developing the disease, benefits of screening), a quote from a veteran who survived CRC, and the phone number patients can call with questions about FOBT.

We interviewed Dr. Samuel Ho and Dr. Jeffery Lee about the intervention:

What aspects of the program can be adapted without it losing its effectiveness? Are there specific audiences (beyond those included in the research study) that you feel this program could be adapted for? Any that it shouldn’t be adapted for?

The mailed reminder itself, regardless of its content, is an important tool to help improve colon cancer screening rates. The main audience are individuals who are 50-75 years of age and are eligible for colorectal cancer screening. Another potential audience, though not studied in our manuscript, would be patients that are higher-risk for colorectal cancer (e.g., patients with a family history of colorectal cancer or personal history of inflammatory bowel disease) compared to the general population.

What do you view as the facilitators to implementation? What might be some challenges?

The key stakeholders are the gastroenterology colleagues who will need to absorb a lot of new patients in need of a screening or diagnostic colonoscopy for follow-up of a positive FIT/FOBT, the IT department to help identify the eligible population and generate mailed reminders, and the medical center/healthcare system to help finance the initiative. Challenges for implementation is lack of financial support and clinicians to help absorb the increasing demand for colonoscopies.

Do you have suggestions for questions that practitioners should include when they evaluate the adaptation/implementation of your program? Do you have specific evaluation tools that would be appropriate for practitioners when they evaluate this program?

If implemented, the practitioners should evaluate the before and after colorectal cancer screening rates. In addition, the practitioners should evaluate the time from receiving a positive screening test (e.g., FIT or FOBT) and getting a follow-up colonoscopy. 

What is your current research focused on?

Optimizing the colorectal cancer screening and surveillance process.