Does the addition of phone calls to a FIT mailing program lead to higher colorectal cancer screening rates?

Background: Distance from healthcare facilities can be a barrier to colorectal cancer (CRC) screening via colonoscopy, particularly for the 42% of veterans living >90 miles from VA medical centers. Fecal immunochemical tests (FITs) require only one sample and were recently approved for VA use. Our objective was to determine if introductory phone calls prior to mailing FITs to veterans overdue for CRC screening plus reminder phone calls resulted in higher screening rates compared to a single mailing of FITs. Methods: A population of 2,516 regular users of VA healthcare ages 51-64 who were asymptomatic, average risk, and overdue for CRC screening were identified; ages 65+ excluded due to likelihood of receiving screening through Medicare. 20% were randomly selected to receive a single mailing of FIT + education materials. 20% served as historical controls and received no intervention. The remaining 60% received an introductory phone call to confirm eligibility and interest prior to mailing FIT, and subsequent reminder phone calls. Results: Of those who received a single FIT mailing, 21% ultimately received CRC screening by any method within 6 months post-mailing. Of those who received an introductory mailing + phone call, 17% received screening within 6 months. 8% of historical controls received screening. Conclusions: While phone calls led to fewer wasted FITs and a lower ‘non-responder' rate, they did not improve overall screening rates. A formal cost-benefit analysis is underway to compare per-subject costs of conducting phone calls to costs associated with unused FITs in a single mailing approach.