Funding: The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR), and the VA Health Services Research and Development (HSR&D) Service, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) (REA 09-220). The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government.
Evaluation of a Home-Based Colorectal Cancer Screening Intervention in a Rural State
Article first published online: 25 OCT 2013
© 2013 National Rural Health Association
The Journal of Rural Health
Volume 30, Issue 3, pages 322–332, Summer 2014
How to Cite
Charlton, M. E., Mengeling, M. A., Halfdanarson, T. R., Makki, N. M., Malhotra, A., Klutts, J. S., Levy, B. T. and Kaboli, P. J. (2014), Evaluation of a Home-Based Colorectal Cancer Screening Intervention in a Rural State. The Journal of Rural Health, 30: 322–332. doi: 10.1111/jrh.12052
Disclosures: The authors report no financial disclosures.
Acknowledgments: The authors would like to thank Stacy Wittrock and Ashley Cozad for their efforts in coordinating this study. We would also like to acknowledge Lindsey Davenport-Landry in the Iowa City VA laboratory for her work in managing all of the laboratory aspects of this project.
- Issue published online: 1 JUL 2014
- Article first published online: 25 OCT 2013
- Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region. Grant Number: VRHRC-CR
- VA Health Services Research and Development. Grant Number: HSR&D
- access to care;
- colorectal cancer screening;
- fecal immunochemical test;
- health services research;
- program evaluation
Distance from health care facilities can be a barrier to colorectal cancer (CRC) screening, especially for colonoscopy. Alternatively, an improved at-home stool-based screening tool, the fecal immunochemical test (FIT), requires only a single sample and has a better sensitivity-specificity balance compared to traditional guaiac fecal occult blood tests. Our objective was to determine if FITs mailed to asymptomatic, average-risk patients overdue for screening resulted in higher screening rates versus mailing educational materials alone or no intervention (ie, usual care).
Veterans ages 51-64, asymptomatic, at average risk for CRC, overdue for screening and in a veterans administration (VA) catchment area covering a large rural population were randomly assigned to 3 groups: (1) education only (Ed) group: mailed CRC educational materials and a survey of screening history and preferences (N = 499); (2) FIT group: mailed the FIT, plus educational materials and survey (N = 500); and (3) usual care (UC) group: received no mailings (N = 500).
At 6 months postintervention, 21% of the FIT group had received CRC screening by any method compared to 6% of the Ed group (and 6% of the UC group) (P < .0001). Of the 105 respondents from the FIT group, 71 (68%) were eligible to take the FIT. Of those, 64 (90%) completed the FIT and 8 (12%) tested positive.
This low-intensity intervention of mailing FITs to average risk patients overdue for screening resulted in a significantly higher screening rate than educational materials alone or usual care, and may be of particular interest in rural areas.