• Stefanie Deeds, Linnaea Schuttner, Chelle Wheat, Eric Gunnink, John Geyer, Lauren Beste, Anders Chen, Jason A Dominitz, Karin Nelson, and Ashok Reddy.
• Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA. Stefanie.Deeds@va.gov.
• J Gen Intern Med. 2024 Jan 1; 39 (1): 113119113-119.

BackgroundThe Veterans Affairs (VHA) is working to establish a population-based colorectal cancer screening program for average-risk patients using mailed fecal immunochemical testing (FIT). However, low response rates to mailed FIT may hinder success. Key features of mailed FIT programs, including the use of reminders, differ among various national programs, with limited evidence among veterans.ObjectiveWe sought to test whether using reminders, either via telephone call or text message, was effective in improving mailed FIT response rates.DesignWe conducted a prospective, randomized quality improvement trial ( ClinicalTrials.gov NCT05012007). Veterans who had not returned a FIT within 2 weeks of receiving the kit were randomized to one of three groups: (1) control (no reminder); (2) an automated telephone call reminder; or (3) an automated text message reminder.ParticipantsA total of 2658 veterans enrolled at VA Puget Sound Health Care System who were aged 45-75 and had an average risk of colorectal cancer.InterventionsA single automated telephone call or text message reminder prompting veterans to return the FIT kit.Main MeasuresOur primary outcome was FIT return at 90 days and our secondary outcome was FIT return at 180 days.Key ResultsParticipant average age was 62 years, 88% were men, and 66% White. At 90 days, both the phone and text reminder interventions had higher FIT return rates compared to control (intention-to-treat results (ITT): control 28%, phone 39%, text 38%; p<0.001). At 180 days, FIT kit return remained higher in the reminder interventions (ITT: control 32%, phone 42%, text 40%; p<0.001).ConclusionsAutomated reminders increased colorectal cancer screening completion among average-risk veterans. An automated phone call or text message was equally effective. VHA facilities seeking to implement a mailed FIT program should consider using phone or text reminders, depending on available resources.© 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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