title: Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care.
  
  
  METHODS
  This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66% were female, 62.1% were Latino, and 70.7% were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data.
  
  
  RESULTS
  Patients who received outreach were more likely to complete FIT than those in usual care (36.7% vs. 14.8%; p < 0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time.
  
  
  CONCLUSIONS
  The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.
authors: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: Shira N
authors: SN
authors: Goldman
authors: David T
authors: DT
authors: Liss
authors: Tiffany
authors: T
authors: Brown
authors: Ji Young
authors: JY
authors: Lee
authors: David R
authors: DR
authors: Buchanan
authors: Kate
authors: K
authors: Balsley
authors: Ana
authors: A
authors: Cesan
authors: Jordan
authors: J
authors: Weil
authors: Bridget H
authors: BH
authors: Garrity
authors: David W
authors: DW
authors: Baker
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003151:Community Health Centers; D057186:Comparative Effectiveness Research / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D035862:Vulnerable Populations