FOBT Completion in FQHCs: Impact of Physician Recommendation, FOBT Information, or Receipt of the FOBT Kit


  • This research was supported by a grant from the National Cancer Institute of the National Institutes of Health R01-CA115869. No financial disclosures were reported by the authors of this paper. We thank Mr. Willie White, Mr. John Winston, Ms. Emma Tarver, Ms. Rosie Kye, Ms. Jeanetta Dean, and Dr. George Henderson for their willingness to participate in clinical research to help improve CRC screening in their clinics. We acknowledge Cristalyn Reynolds, MA; Ivory Davis, MSN; Cara Pugh, BSN; David Neal; and Annie Miller, BSW, for their skill in interviewing patients and collecting and entering data. For further information, contact: Terry C. Davis, PhD, Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130; e-mail


Purpose: To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion within rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics.

Methods: We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected.

Findings: Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P= .002; FOBT education: P= .001; physician giving FOBT kit: P < .0001). In urban clinics, only physician giving the kit predicted FOBT completion (P < .0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs 2.1; P= .0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P= .0002), or receiving an FOBT kit from their physician (RR: 22.3 vs 10.1; P= .035).

Conclusions: Participants who receive an FOBT kit from their physician are more likely to complete screening.