Sending patients personalized electronic reminders for colorectal cancer screening may encourage a number of them to turn up, resulting in an increase in screening rates over the short term, researchers from Brigham and Women’s Hospital, Harvard Medical School and Harvard Vanguard Medical Associates, Boston, wrote in Archives of Internal Medicine.
As background information, the authors informed that colorectal cancer is the second cancer killer in the USA. Treatment is much more effective if caught and treated early on.
They wrote:
- “Colorectal cancer screening detects cancers at more curable early stages and reduces colorectal cancer mortality. As a result, national guidelines strongly recommend screening with colonoscopy, flexible sigmoidoscopy or fecal occult blood testing for average-risk adults older than 50 years.”
Up to 90 million people in the USA who have not been screened would benefit from the procedure.
Thomas D. Sequist, M.D., M.P.H. and team carried out a randomized, controlled study involving 1,103 patients aged 50 to 75 at one group practice – the trial was looking at the effectiveness of using an electronic patient messaging system. All participants had an electronic personal health record, which contained data of their future colorectal cancer screening dates. Half of them – the Electronic Messaging Group – were randomly selected to receive one electronic message from their doctor if they had missed their screening appointment. They also received a link to a Web-based tool so they could assess their risk of developing colorectal cancer. The other half – the Control Group – received no electronic messages if they missed a screening appointment.
Within four weeks of sending the electronic messages, the Electronic Messaging Group had a significantly higher screening rate (8.3%) than the Control Group (0.2%). Within four months, however, the 13.1% of the Control Group had been screened and 15.8% of the Electronic Group – this is not considered as a significant difference.
54% of the patients who got a message saw it, and 9% went on to use the Web-based assessment tool. 19% of those who used the Web-based tool were found to have a higher risk than average of developing colorectal cancer. 17% of those who used the Web-based tool subsequently requested a screening, compared to 4% of those who did not view the tool.
The authors believe the two groups evened out after a while because of other existing reminders, such as annual paper mailings.
The researchers said:
- “Patients have expressed interest in interacting with their medical record using electronic portals similar to the one used in our intervention. Further research is needed to understand the most effective ways for patients to use interactive health information technology to improve their care and to reduce the morbidity and mortality of colorectal cancer.”
Another article in the same journal describes a randomized, controlled trial carried out by Kenzie A. Cameron, Ph.D., M.P.H., and colleagues at Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago. The trial involved 638 patients aged 50 to 79 who were overdue for screening colonoscopy. Half of them got a mailing containing a reminder letter, a brochure and a DVD about the screening process and colorectal cancer – they also received a follow-up phone call. The rest received nothing until the study period was completed.
9.9% of those in the Intervention Group had a screening, compared to 3.2% in the Control Group. Six months later the Intervention Group rate was 18.2%, compared to 12.1% in the Control Group.
34.7% of telephone attempts eventually got through to the patient. 95% of telephoned patients said they had received information, and 98% of them claimed to have read the letter and brochure, while 30% watched the DVD. 32.4% of those who did not watch the DVD said they were too busy, 20.7% did not see it because they thought they knew enough about screening anyway, while 12.9% said they were not interested. 10.4% said they did not have a DVD player or did not know how to use one. “This result suggests that it might not be worthwhile to include educational videos as part of mailed multicomponent patient outreach interventions.”
The authors concluded:
- “Because the screening rate remained low, additional research is needed to determine how to best promote screening in this patient group. At present, health systems could reasonably choose to begin screening promotion with low-cost interventions like simple mailings followed by more expensive, but potentially more effective interventions such as one-on-one patient navigation or interventions aimed at eliminating structural barriers for patients who remain unscreened.”
Thomas D. Sequist, MD, MPH; Alan M. Zaslavsky, PhD; Graham A. Colditz, MD, DrPH; John Z. Ayanian, MD, MPP
Arch Intern Med. Published online December 13, 2010. doi:10.1001/archinternmed.2010.467
Written by Christian Nordqvist