A randomized controlled trial to improve colon cancer screening in rural family medicine: an Iowa Research Network (IRENE) study

Background: Many adults have not been screened for colon cancer, a potentially preventable cause of death. Methods: This was a randomized controlled trial conducted between December 2008 and April 2011 to improve CRC screening in 16 rural family physician offices. Subjects due for CRC screening were randomized within each practice to 1 of 4 groups: (1) usual care; (2) physician chart reminder; (3) physician chart reminder, mailed education, CRC reminder magnet, and fecal immunochemical test (FIT) (mailed education/FIT); or (4) all the preceding plus a structured telephone call to the patient from project staff to provide education, assess interest in screening, explain the screening tests, and address barriers (mailed education/FIT plus phone call). The main outcome was completion of any CRC screening. Results: This study enrolled 743 patients. CRC screening was completed by 17.8% in the usual care group, 20.5% in the chart reminder group, 56.5% in the mailed education/FIT group, and 57.2% in the mailed education/FIT plus phone call group. We found no effect from the chart reminder compared with usual care (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.7–2.0); and a beneficial effect from the mailed education/FIT (OR, 6.0; 95% CI, 3.7–9.6) and the mailed education/FIT plus phone call (OR, 6.2; 95% CI, 3.8–9.9). Both FIT and colonoscopy rates increased significantly in both mailed education groups. Conclusion: CRC screening rates increased significantly among patients who were overdue for screening after they received mailed educational materials and a FIT. The addition of a phone call did not further increase screening rates.