title: Evaluation of a home-based colorectal cancer screening intervention in a rural state.
abstract: OBJECTIVE
  Distance from health care facilities can be a barrier to colorectal cancer (CRC) screening, especially for colonoscopy. Alternatively, an improved at-home stool-based screening tool, the fecal immunochemical test (FIT), requires only a single sample and has a better sensitivity-specificity balance compared to traditional guaiac fecal occult blood tests. Our objective was to determine if FITs mailed to asymptomatic, average-risk patients overdue for screening resulted in higher screening rates versus mailing educational materials alone or no intervention (ie, usual care).
  
  
  METHODS
  Veterans ages 51-64, asymptomatic, at average risk for CRC, overdue for screening and in a veterans administration (VA) catchment area covering a large rural population were randomly assigned to 3 groups: (1) education only (Ed) group: mailed CRC educational materials and a survey of screening history and preferences (N = 499); (2) FIT group: mailed the FIT, plus educational materials and survey (N = 500); and (3) usual care (UC) group: received no mailings (N = 500).
  
  
  RESULTS
  At 6 months postintervention, 21% of the FIT group had received CRC screening by any method compared to 6% of the Ed group (and 6% of the UC group) (P < .0001). Of the 105 respondents from the FIT group, 71 (68%) were eligible to take the FIT. Of those, 64 (90%) completed the FIT and 8 (12%) tested positive.
  
  
  CONCLUSIONS
  This low-intensity intervention of mailing FITs to average risk patients overdue for screening resulted in a significantly higher screening rate than educational materials alone or usual care, and may be of particular interest in rural areas.
authors.affiliation: VA Office of Rural Health, Rural Health Resource Center-Central Region, and the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mengeling
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
authors.forename: Nader M
authors.initials: NM
authors.lastname: Makki
authors.forename: Ashish
authors.initials: A
authors.lastname: Malhotra
authors.forename: J Stacey
authors.initials: JS
authors.lastname: Klutts
authors.forename: Barcey T
authors.initials: BT
authors.lastname: Levy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007484:Iowa; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D014728:Veterans
keywords: access to care; colorectal cancer screening; fecal immunochemical test; health services research; program evaluation