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Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

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A Capsule Commentary to this article was published on 03 October 2013

ABSTRACT

BACKGROUND

Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments.

OBJECTIVE

To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice.

DESIGN

Pragmatic randomized trial.

PARTICIPANTS

Men and women aged 50–74 years past due for CRC screen and women aged 40–74 years past due for BC screening.

INTERVENTIONS

We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call).

MAIN MEASURES

Documentation of mammography or colorectal cancer screening at 52 weeks following randomization.

KEY RESULTS

Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2–4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1–3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1–3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0–3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates.

CONCLUSIONS

The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.

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Acknowledgments

Contributors

All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline.

Grant Support

This project was supported by the American Cancer Society - RSGT-08-077-01-CPHPS.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Center for Primary Care and Department of Internal Medicine, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY, 14609, USA

    Robert J. Fortuna MD, MPH & Steven Scofield MD

  2. Department of Family Medicine and Community & Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Amna Idris MPH, Paul Winters MS, Patricia Ford MS, Shirley X. L. Li B SciH & Kevin Fiscella MD, MPH

  3. Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA

    Sharon G. Humiston MD, MPH

  4. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Samantha Hendren MD, MPH

  5. Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY, 14620, USA

    Kevin Fiscella MD, MPH

Authors
  1. Robert J. Fortuna MD, MPH
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  2. Amna Idris MPH
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  4. Sharon G. Humiston MD, MPH
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  6. Samantha Hendren MD, MPH
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  9. Kevin Fiscella MD, MPH
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Corresponding author

Correspondence to Kevin Fiscella MD, MPH.

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Fortuna, R.J., Idris, A., Winters, P. et al. Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening. J GEN INTERN MED 29, 90–97 (2014). https://doi.org/10.1007/s11606-013-2586-y

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