A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations.

Martinez, Maria Elena; Roesch, Scott; Largaespada, Valesca; Castañeda, Sheila F; Nodora, Jesse N; Rabin, Borsika A; Covin, Jennifer; Ortwine, Kristine; Preciado-Hidalgo, Yesenia; Howard, Nicole; Schultz, James; Stamm, Nannette; Ramirez, Daniel; Halpern, Michael T; Gupta, Samir

Martinez, Maria Elena; Roesch, Scott; Largaespada, Valesca; Castañeda, Sheila F; Nodora, Jesse N; Rabin, Borsika A; Covin, Jennifer; Ortwine, Kristine; Preciado-Hidalgo, Yesenia; Howard, Nicole; Schultz, James; Stamm, Nannette; Ramirez, Daniel; Halpern, Michael T; Gupta, Samir.

Afiliação

Martinez ME; Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
Roesch S; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
Largaespada V; Department of Psychology, San Diego State University, San Diego, California, USA.
Castañeda SF; Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
Nodora JN; Department of Psychology, San Diego State University, San Diego, California, USA.
Rabin BA; Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
Covin J; Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA.
Ortwine K; Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA.
Preciado-Hidalgo Y; Health Quality Partners of Southern California, San Diego, California, USA.
Howard N; Integrated Health Partners of Southern California, San Diego, California, USA.
Schultz J; Health Quality Partners of Southern California, San Diego, California, USA.
Stamm N; Health Quality Partners of Southern California, San Diego, California, USA.
Ramirez D; Neighborhood Healthcare, Escondido, California, USA.
Halpern MT; Vista Community Clinic, Vista, California, USA.
Gupta S; San Ysidro Health, San Ysidro, California, USA.

Cancer ; 2024 May 25.

Article em En | MEDLINE | ID: mdl-38795024

ABSTRACT

ABSTRACT

BACKGROUND:

Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity.

METHODS:

A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant.

RESULTS:

Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals).