title: Mailed participant reminders are associated with improved colonoscopy uptake after a positive FOBT result in Ontario's ColonCancerCheck program.
abstract: BACKGROUND
  Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. This study evaluates the effectiveness of two ongoing interventions designed to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario's population-wide ColonCancerCheck program. The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonoscopy. The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up.
  
  
  METHODS
  Prospective cohort study using Ontario's ColonCancerCheck program data sets (2008-2011), linked to provincial administrative health databases. Crude rate ratios were calculated to assess determinants of colonoscopy uptake among an Ontario-wide FOBT-positive cohort with rolling enrolment, followed from October 2008 through February 2011. Segmented time-series regression was used to assess the average additional change in colonoscopy uptake after FOBT-positive status following the introduction of two ongoing interventions among the same cohort.
  
  
  RESULTS
  A notification mailed directly to FOBT-positive screening participants was observed to increase colonoscopy uptake, beyond the modest average underlying increase throughout the study period, by an average of 3% per month (multivariable-adjusted RR: 1.03, 95% CI: 1.00-1.06). However, revision of the existing FOBT result notification to physicians was observed to have no effect.
  
  
  CONCLUSIONS
  Direct participant notification of a positive FOBT result improved adherence with follow-up colonoscopy in Ontario's population-wide ColonCancerCheck program. Further participant-directed interventions may be effective means of maximizing adherence in population-wide screening.
authors.affiliation: Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. david.stock@sunnybrook.ca.
authors.forename: David
authors.initials: D
authors.lastname: Stock
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Linda.Rabeneck@cancercare.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Linda.Rabeneck@cancercare.on.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Linda.Rabeneck@cancercare.on.ca.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Linda.Rabeneck@cancercare.on.ca.|Cancer Care Ontario, Toronto, Ontario, Canada. Linda.Rabeneck@cancercare.on.ca.
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. BaxterN@smh.toronto.on.ca.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. BaxterN@smh.toronto.on.ca.|Department of General Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. BaxterN@smh.toronto.on.ca.|Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada. BaxterN@smh.toronto.on.ca.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. lawrence.paszat@ices.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. lawrence.paszat@ices.on.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. lawrence.paszat@ices.on.ca.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Paszat
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Rinku.Sutradhar@ices.on.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Rinku.Sutradhar@ices.on.ca.
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Lingsong.Yun@ices.on.ca.
authors.forename: Lingsong
authors.initials: L
authors.lastname: Yun
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca.|Cancer Care Ontario, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca.|Sunnybrook Health Sciences Centre, 2075 Bayview Ave Rm HG40, Toronto, ON, M4N 3M5, Canada. jill.tinmouth@sunnybrook.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000523:psychology; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011177:Postal Service / Q000379:methods; D011446:Prospective Studies; D017010:Reminder Systems