Automated, Personalized Outreach Boosts CRC Screening in Diverse Patient Population

— Absolute improvement of 30-40% in screening participation after 1 year

A photo of a fecal immunochemical test kit.

Automated and personalized outreach about colorectal cancer (CRC) screening led to substantial increases in participation across a diverse patient population, according to a study involving more than 1 million people.

Automated outreach increased screening participation by 30% to 38% among various demographic groups, and follow-up personalized outreach by an additional 11% to 15%. Screening participation was similar in men and women, and older patients were more likely to be up to date with CRC screening before and after the study.

Rates of screening participation increased from 74% to 84% across all racial and ethnic groups, far exceeding the national average, reported Clara Podmore, MD, PhD, of Lausanne University Hospital in Switzerland, and co-authors in .

"Our findings suggest that personalized screening approaches further boosted completion of screening in all members, beyond universal automated approaches, with a larger contribution among Black, Hispanic, and Native Hawaiian or other Pacific Islander members and among younger members," the authors wrote of their findings. "Outcomes associated with personalized approaches delivered to younger members are particularly relevant because, since 2021, the U.S. Preventive Services Task Force has also recommended CRC screening among individuals aged 45 to 49 years."

"Our findings suggest that being approached by a known and trusted individual from a PCP's [primary care provider's] office may enhance completion of screening, particularly among individuals with lower initial responses to automated outreach," they added.

Conducted within the Kaiser Permanente Northern California (KPNC) patient population, the outreach program, which included mailed fecal immunochemical test (FIT) kits, increased rates of screening participation across all racial and ethnic groups, noted the authors of an .

"The fact that mailed FIT kits and automatic reminders alone could achieve screening rates among all racial and ethnic groups of KPNC members exceeding the national average is a testament to the public health benefit that can be achieved with annual FIT kit mailing in the clinical setting," wrote Alexa L. Pohl, MD, PhD, and Arden M. Morris, MD, MPH, of Stanford University in California.

These study results "suggest that persistence and personalization make important contributions to achieving screening targets," they added. "Given that a simple stool test can level the playing field for all against the nation's second leading cancer killer, healthcare organizations around the U.S. should not wait before implementing their own comprehensive colorectal cancer screening programs."

CRC incidence and mortality remain disproportionately high among minority populations, particularly Black patients. From 2006 to 2008, KPNC implemented a multistep screening program based primarily on mailed FIT kits to members who were not up to date with screening. By 2018, racial/ethnic differences in CRC incidence and mortality , noted Podmore and co-authors.

Targeting KPNC members who are not up to date with CRC screening, the begins with automated outreach (mailed reminders and FIT kits, automated telephone calls, and postcard reminders), followed by personalized components for non-responders (telephone calls, electronic messaging, and screening offers during office visits).

Several randomized trials have shown that FIT outreach, patient navigation, patient education, and patient reminders all can . However, various interventions require different levels of resources, the authors continued. Additionally, little is known about the relative effectiveness of various outreach strategies among different racial/ethnic groups.

For this study, Podmore and colleagues examined records for 1,045,745 KPNC members eligible for CRC screening at the beginning of 2019. The primary outcome was the proportion of participants who completed FIT or colonoscopy after each component of the screening process.

The study population had a racial/ethnic distribution of 0.4% American Indian/Alaska Native, 18.5% Asian, 7.2% Black, 16.2% Hispanic, 0.8% Native Hawaiian/other Pacific Islander, and 56.5% white. Women accounted for 53.2% of the participants.

At the end of 2018, 28% to 36% of KPNC members by racial/ethnic group were up to date with CRC screening. Automated screening was associated with absolute increases in screening participation ranging from 29.5% among Black patients to 38.1% among Asians. Follow-up personalized outreach led to additional increases ranging from 11.2% among white patients to 14.7% among Native Hawaiian/other Pacific Islander patients. By the end of 2019, the proportion of KPNC members who were up to date with CRC screening ranged from 74.4% among American Indian/Alaska Native participants to 83.5% among Asian members.

Of FIT results, 3.3% to 4.7% were positive, and 80.4% to 82.9% of participants with positive tests completed follow-up colonoscopy within 180 days, except for Native Hawaiian/other Pacific Islander members (72.9%).

For health systems considering implementation of an outreach program, a logical concern is the associated costs, Podmore and co-authors acknowledged. Estimates for similar interventions vary widely. A showed that estimated costs ranged from $1,000 to $3,500 per person screened. A in Washington involving FIT mailings and telephone reminders had a total cost of about $40 per FIT kit returned.

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    Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined app in 2007.


The study was supported by the National Cancer Institute.

Podmore reported no relevant relationships with industry.

Pohl and Morris reported no relevant relationships with industry.

Primary Source

JAMA Network Open

Podmore C, et al "Colorectal cancer screening after sequential outreach components in a demographically diverse cohort" JAMA Netw Open 2024; DOI: 10.100/jamanetworkopen.2024.5295.

Secondary Source

JAMA Network Open

Pohl AL, Morris AM "Automated and personalized outreach to level the playing field for colorectal cancer screening" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.5260.