A randomized controlled trial of tailored navigation and standard intervention in colorectal cancer screening

Background. This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer (CRC) screening adherence and screening decision stage (SDS). Methods. Primary care patients (n=945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n=312), Standard Intervention (SI) Group (n=316), or usual care Control Group (n=317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months. Results. The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (p=0.001 and p=0.001, respectively), but the two intervention groups did not differ significantly (p=0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (p=0.001 and p=0.001, respectively), and the intervention group difference approached significance (p=0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options. Conclusions. Both interventions had significant, positive effects on outcomes compared to usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS. Impact. Mailed screening tests can boost adherence. Research should determine differential effects of preference, access, and navigation on screening outcomes.