Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial

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Abstract

Background

Fecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation.

Objective

The objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result.

Methods

This randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude.

Results

Overall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders ( P=.001).

Conclusions

A text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests.

Trial Registration

ClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl)

Related collections

Most cited references 40

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Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer.

Machelle D. Wilson, G Libby, David J R Steele … (2009)

To assess the effects of the first three rounds of a pilot colorectal screening programme based on guaiac faecal occult blood testing (gFOBT) and their implications for a national population-based programme. A demonstration pilot programme was conducted in three Scottish NHS Boards. Residents aged between 50 and 69 years registered on the Community Health Index were included in the study. In the first round, the uptake was 55.0%, the positivity rate was 2.07% and the cancer detection rate was 2.1/1000 screened. In the second round, these were 53.0%, 1.90% and 1.2/1000, respectively, and in the third round, 55.3%, 1.16% and 0.7/1000, respectively. In the first round, the positive predictive value of the gFOBT was 12.0% for cancer and 36.5% for adenoma; these fell to 7.0% and 30.3% in the second round and were maintained at 7.5% and 29.1% in the third round. The percentage of screen-detected cancers diagnosed at Dukes' stage A was 49.2% in the first round, 40.1% in the second round and 36.3% in the third round. These results are compatible with those of previous randomised trials done in research settings, demonstrating that population-based colorectal cancer screening is feasible in Scotland and should lead to a comparable reduction in disease-specific mortality.

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Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review

Joanne L Callen, Johanna Westbrook, Andrew Georgiou … (2011)

ABSTRACT BACKGROUND Serious lapses in patient care result from failure to follow-up test results. OBJECTIVE To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients. DATA SOURCES Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010. STUDY SELECTION Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices. DATA EXTRACTION Four reviewers independently screened 768 articles. RESULTS Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used. LIMITATIONS Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries. CONCLUSIONS Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.

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Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems

M. Garcia, A Burnett-Hartman, Y. Zheng … (2016)

Background To reduce colorectal cancer (CRC) mortality, positive fecal blood tests must be followed by colonoscopy. Methods We identified 62,384 individuals aged 50–89 years with a positive fecal blood test between 1/1/2011 and 12/31/2012 in four healthcare systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CIs) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. Hazard ratios and 95% CIs were estimated from multivariate Cox proportional hazards models. Results Most patients who received a colonoscopy did so within six months of their positive fecal blood test, although follow-up rates varied across healthcare systems (p <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40–41) to 174 (95% CI, 123–343); percent followed-up by 12-months ranged from 58.1% (95% CI, 51.6%–63.7%) to 83.8% (95% CI, 83.4%–84.3%) and differences across healthcare systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates. Conclusion Individual characteristics and healthcare system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across healthcare systems, but proportions of patients receiving follow-up varied. These findings suggest there is room to improve follow-up of positive CRC screening tests. Impact Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up.

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Author and article information

Contributors

Revital Azulay:

Central LaboratoryMeuhedet Health CarePesach Lev 5Lod,Israel972 97289130421972 97289130422eazulay39@gmail.com

ORCID: http://orcid.org/0000-0002-7523-0156

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: February 2019

Publication date (Electronic): 05 February 2019

Volume: 7

Issue: 2

Electronic Location Identifier: e11114

Affiliations

[1 ] Master of Health Administration Program, Department of Management Bar Ilan University Ramat Gan Israel

[2 ] Central Laboratory Meuhedet Health Care Lod Israel

[3 ] Quality Department Meuhedet Health Care Tel Aviv Israel

Author notes

Corresponding Author: Revital Azulay eazulay39@ 123456gmail.com

Author information

Revital Azulay http://orcid.org/0000-0002-7523-0156

Liora Valinsky http://orcid.org/0000-0003-0285-6681

Fabienne Hershkowitz http://orcid.org/0000-0001-6251-5219

Racheli Magnezi http://orcid.org/0000-0003-1944-5897

Article

Publisher ID: v7i2e11114

DOI: 10.2196/11114

PMC ID: 6379817

PubMed ID: 30720439

SO-VID: 65580899-28fd-4acf-be8c-52f1159e0fc6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 23 May 2018

Date revision requested : 7 August 2018

Date revision received : 25 August 2018

Date accepted : 26 October 2018

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