• Stefanie Deeds, Terrence Liu, Linnaea Schuttner, Chelle Wheat, Eric Gunnink, John Geyer, Lauren Beste, Anders Chen, Jason A Dominitz, Kari Nelson, and Ashok Reddy.
• Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Stefanie.Deeds@va.gov.
• J Gen Intern Med. 2023 Nov 1; 38 (14): 323532413235-3241.

BackgroundMailed fecal immunochemical testing (FIT) programs are increasingly utilized for population-based colorectal cancer (CRC) screening. Advanced notifications (primers) are one behavioral designed feature of many mailed FIT programs, but few have tested this feature among Veterans.ObjectiveTo determine if an advanced notification, a primer postcard, increases completion of FIT among Veterans.DesignThis is a prospective, randomized quality improvement trial to evaluate a postcard primer prior to a mailed FIT versus mailed FIT alone.ParticipantsA total of 2404 Veterans enrolled for care at a large VA site that were due for average-risk CRC screening.InterventionA written postcard sent 2 weeks in advance of a mailed FIT kit that contained information on CRC screening and completing a FIT.Main MeasuresOur primary outcome was FIT completion at 90 days, and our secondary outcome was FIT completion at 180 days.Key ResultsOverall, unadjusted mailed FIT return rates were similar among control vs. primer arms at 90 days (27% vs. 29%, p = 0.11). Our adjusted analysis found a primer postcard did not increase FIT completion compared to mailed FIT alone (OR 1.14 (0.94, 1.37)).ConclusionsThough primers are often a standard part of mailed FIT programs, we did not find an increase in FIT completion with mailed postcard primers among Veterans. Given the overall low mailed FIT return rates, testing different ways to improve return rates is essential to improving CRC screening.© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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