title: A pilot study for using fecal immunochemical testing to increase colorectal cancer screening in Appalachia, 2008-2009.
abstract: BACKGROUND
  The Appalachian region of the United States has disproportionately high colorectal cancer (CRC) death rates and low screening rates. The purpose of this pilot study was to assess acceptability of a take-home fecal immunochemical test (FIT) and the effect of follow-up telephone counseling for increasing CRC screening in rural Appalachia.
  
  
  METHODS
  We used a prospective, single-group, multiple-site design, with centralized laboratory reports of screening adherence and baseline and 3-month questionnaires. Successive patients, aged 50 or older, at average CRC risk and due for screening were enrolled during a routine visit to 3 primary care practices in rural Appalachian Pennsylvania and received a free take-home FIT and educational brochure. Those who had not returned the test 2 weeks later were referred for telephone counseling.
  
  
  RESULTS
  Of 232 patients approached, 200 (86.2%) agreed to participate. Of these, 145 (72.5%) completed the FIT as recommended (adherent) and 55 (27.5%) were referred for telephone counseling (nonadherent), of whom 23 (41.8%) became adherent after 1 to 2 counseling sessions, an 11.5 percentage-point increase in screening after telephone counseling and 84% FIT adherence overall. Lack of CRC-related knowledge and perceived CRC risk were the screening barriers most highly associated with nonadherence. Although not statistically significant, the rate of conversion to screening adherence was higher among participants who received telephone counseling compared to an answering machine reminder.
  
  
  CONCLUSIONS
  If confirmed in future randomized trials, provider-recommended take-home FIT and follow-up telephone counseling may be methods to increase CRC screening in Appalachia.
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University College of Medicine, 600 Centerview Dr, Room 2200, Mailstop A210, Hershey, PA 17033, USA. bck10@psu.edu
authors.forename: Brenda C
authors.initials: BC
authors.lastname: Kluhsman
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Lengerich
authors.forename: Linda
authors.initials: L
authors.lastname: Fleisher
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Miller-Halegoua
authors.forename: Andrew
authors.initials: A
authors.lastname: Balshem
authors.forename: Marcyann M
authors.initials: MM
authors.lastname: Bencivenga
authors.forename: Angela M
authors.initials: AM
authors.lastname: Spleen
authors.forename: Paulette
authors.initials: P
authors.lastname: Schreiber
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dignan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003376:Counseling; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010865:Pilot Projects; D011446:Prospective Studies; D012424:Rural Population; D013689:Telephone