title: Efficacy of a Telehealth Intervention on Colonoscopy Uptake When Cost Is a Barrier: The Family CARE Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  We tested the efficacy of a remote tailored intervention Tele-Cancer Risk Assessment and Evaluation (TeleCARE) compared with a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers.
  
  
  METHODS
  Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N = 232) or an educational brochure (N = 249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained nonadherent. Rates of medically verified colonoscopy at the 15-month follow-up were compared on the basis of group assignment and within group stratification by cost barriers.
  
  
  RESULTS
  In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy [OR, 2.37; 95% confidence interval (CI) 1.59-3.52]. Cost was identified as a barrier in both groups (TeleCARE = 62.5%; educational brochure = 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR, 3.66; 95% CI, 1.85-7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR, 1.99; 95% CI, 1.12-3.52).
  
  
  CONCLUSIONS
  TeleCARE increased colonoscopy regardless of cost barriers.
  
  
  CONCLUSIONS
  Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent.
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico. Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Steffen
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. Department of Oncologic Sciences, University of Utah, Salt Lake City, Utah.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Damron
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Pappas
authors.affiliation: Department of School of Public Health Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, Texas.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Walters
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Flores
authors.affiliation: Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Watcharaporn
authors.initials: W
authors.lastname: Boonyasiriwat
authors.affiliation: Division of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, Texas.
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway Township, New Jersey. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Department of Oncology, Georgetown University, Washington, DC. Lombardi Comprehensive Cancer Center, Washington, DC.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
authors.affiliation: Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Edwards
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Kohlmann
authors.affiliation: Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Lowery
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Wiggins
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hill
authors.affiliation: Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama.
authors.forename: John C
authors.initials: JC
authors.lastname: Higginbotham
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Randall
authors.initials: R
authors.lastname: Burt
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Simmons
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico. AYKinney@salud.unm.edu.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
mesh_terms: D000328:Adult; D003113:Colonoscopy / Q000191:economics* / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data; D005249:Fees and Charges; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011159:Population Surveillance / Q000379:methods*; D011177:Postal Service / Q000706:statistics & numerical data; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone