Article Title

Using Novel Multimodal Reminders for a Direct-Mail Fecal Testing Program: Findings From STOP CRC

Publication Date



cancer, pragmatic trials, dissemination and implementation of innovations, health promotion, prevention, screening


Background: Evidence shows that reminders can improve rates of patient adherence to completion of cancer screening tests. Less is known about the efficacy of reminders in relation to direct-mail fecal testing programs. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) study, we sought to compare the effectiveness of multimodal reminders for a direct-mail fecal testing program.

Methods: We tested screening reminders in four clinics at Sea Mar, a community health center in Washington State. Adults aged 50–75 years who had a primary care visit in the previous year and were not up to date with colorectal cancer screening received an informational letter and fecal immunochemical test (FIT) kit by mail. Patients who did not return their FIT kits within 3 weeks were sent a message through the patient portal or randomized to receive: 1) a reminder letter; 2) three automated phone calls; 3) three text messages; 4) a live phone call; 5) a text message and a live phone call; 6) a reminder letter and a live phone call; or 7) an automated and live phone call. We recorded rates of screening completion and rates of patients reached by reminder.

Results: On initial data analysis, reach among combined strategies was highest for automated and live phone call (27%). For single-modal reminder strategies, reach was highest for live phone call (30%) and lowest for text message (13%). We are currently receiving data on the last clinics. Final results will be presented in the poster.

Conclusion: To date, in the federally qualified health center setting, automated and live phone call reminders to a direct-mail fecal testing program substantially increase colorectal cancer screening rates.




July 31st, 2017


August 10th, 2017