Improving fecal occult blood testing compliance using a mailed educational reminder.
BACKGROUND
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low.


OBJECTIVE
To determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance.


METHODS
Blinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California.


METHODS
Seven hundred and seventy-five consecutive patients > or =50 years of age referred by their primary care physicians for FOBT.


METHODS
Patients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only.


METHODS
The primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis.


RESULTS
At 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P < 0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48-2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29-2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13-0.50).


CONCLUSIONS
A simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.
Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, CA 92161, USA.
Jeffrey K
JK
Lee
Veronica
V
Reis
Shanglei
S
Liu
Lorraine
L
Conn
Erik J
EJ
Groessl
Theodore G
TG
Ganiats
Samuel B
SB
Ho
D000368:Aged; D001071:Appointments and Schedules; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D004311:Double-Blind Method; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D011177:Postal Service / Q000379:methods*; D017010:Reminder Systems