Automated Telephone Reminders Increase Colon Cancer Screenings

Article Outline

• Copyright

Simple, automated telephone reminders can increase colorectal cancer (CRC) screening rates by 30%, according to a Kaiser Permanente Center for Health Research study funded by the National Cancer Institute that appears in the July edition of Medical Care.

The study—the first to examine whether automated calls can increase CRC screening—was conducted in 2008 and involved nearly 6000 Kaiser Permanente members in Oregon and Washington who were overdue for screening. The patients, aged 51–80 years, were at average risk for CRC and due for screening.

In this randomized, controlled trial, half of the participants received up to three, 1-minute, automated telephone calls that provided the health benefits of fecal occult blood test (FOBT) screening. During the call, patients could press a number on their phone if they wanted to order a free kit to be mailed to their home. Those who requested but did not return the cards within 6 weeks received an automated reminder call, and if they did not respond in another 6 weeks, they received a third call.

Within 6 months, 22.5% in the intervention group had completed an FOBT, compared with only 16% of those in the usual care group. Older patients (aged 71–80 vs 51–60 years) were also more likely to complete an FOBT.

“This study shows that simple, automated calls motivate more people to take the test, and that means we will detect more cancers at an early stage when we can still save lives” says Adrianne Feldstein, MD, the study's principal author and a researcher at the Kaiser Permanente Center for Health Research.

Other studies have found live phone calls very effective in boosting cancer screening rates, but because those calls require hiring extra people, they are cost prohibitive for many health care organizations. Other research found that reminder postcards can boost screening rates, but automated phone calls are less expensive than postcards because the cost per call decreases as the number of calls increases. An automated call system could be implemented easily by public and private health care systems, especially those with fewer resources, state the authors.

In this study, patients received calls because they had not had a colonoscopy in the last 10 years, a flexible sigmoidoscopy or barium enema in the last 5 years, an FOBT in the past 12 months, or a clinician referral for FOBT or barium enema within the last 3 months. The automated calls were in English and Spanish.

“Further research is needed to evaluate automated telephone interventions among diverse populations and in other clinical settings,” the authors state. See Med Care, 2010;48:604–610.