title: Strategies to improve repeat fecal occult blood testing cancer screening.
abstract: BACKGROUND
  A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing.
  
  
  METHODS
  Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in eight community clinics in Louisiana. Clinics were randomly assigned to receive: enhanced care, a screening recommendation, and FOBT kit annually; a brief educational intervention where patients additionally received a literacy appropriate pamphlet and simplified FOBT instructions; or nurse support where a nurse manager provided the education and followed up with phone support. In year 2, all materials were mailed. The study consisted of 461 patients, ages 50 to 85 years, with a negative initial FOBT.
  
  
  RESULTS
  Repeat FOBT rates were 38% enhanced care, 33% education, and 59% with nurse support (P = 0.017). After adjusting for age, race, gender, and literacy, patients receiving nurse support were 1.46 times more likely to complete repeat FOBT screening than those receiving education [95% confidence interval (CI), 1.14-1.06; P = 0.002] and 1.45 times more likely than those in enhanced care but this was not significant (95% CI, 0.93-2.26; P = 0.10). The incremental cost per additional person screened was $2,450 for nurse over enhanced care.
  
  
  CONCLUSIONS
  A mailed pamphlet and FOBT with simplified instructions did not improve annual screening.
  
  
  CONCLUSIONS
  Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT, yet this may be too costly for community clinics.
authors.affiliation: Authors' Affiliations: Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana; South Carolina College of Pharmacy, the Hollings Cancer Center of the Medical University of South Carolina, the Arnold School of Public Health, and the William Jennings Bryan Veterans Administration Medical Center, Charleston and Columbia, South Carolina; Division of General Internal Medicine & Geriatrics; and Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Cristalyn
authors.initials: C
authors.lastname: Reynolds
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis / Q000191:economics; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood