Text reminders and letters increased FIT completion in overdue colorectal cancer screening patients

This randomized trial was conducted in a primary care setting and enrolled 5244 patients aged 50 to 74 years who were overdue for colorectal cancer screening. The study population consisted of individuals identified as overdue for screening within the primary care system. The primary outcome measured was the proportion of patients who completed a fecal immunochemical test within 4 months of the intervention. The follow-up period for the study was 4 months. No serious adverse events or discontinuations were reported, and tolerability data were not reported. Funding or conflicts of interest were not reported.

The intervention group received a health system-branded blue box, text reminders, and a reminder letter. The comparator group received a standard envelope with no text reminders and no reminder letter. The text reminder component was compared against no text reminders, and the letter component was compared against no reminder letter. The health system-branded box component was evaluated separately to determine its impact on response rates.

For the primary outcome of FIT completion, the overall comparison between the box group and the envelope group showed no difference. The completion rate was 17.8% for the box group versus 18.0% for the envelope group. The effect size was -0.2%. The 95% confidence interval ranged from -2.3% to 1.9%, and the P value was .85. This indicates that the branded box alone did not increase screening completion.

When analyzing the text reminder component, completion of FIT was 21.2% in the text reminder group versus 14.6% in the no text group. The effect size was 6.6%. The 95% confidence interval was 4.6% to 8.7%, and the P value was less than .001. This demonstrates a statistically significant increase in screening completion associated with text reminders.

For the reminder letter component, completion of FIT was 20.3% in the reminder letter group versus 15.5% in the no reminder letter group. The effect size was 4.8%. The 95% confidence interval was 2.7% to 6.9%, and the P value was less than .001. This demonstrates a statistically significant increase in screening completion associated with mailed reminder letters.

Safety and tolerability findings were limited by the lack of reported data. Adverse events were not reported, serious adverse events were not reported, discontinuations were not reported, and tolerability was not reported. The study design was a randomized trial, which supports causal inference regarding the interventions tested. No methodological limitations were explicitly listed in the provided data.

These results suggest that behaviorally informed text messaging and mailed reminders significantly increase screening completion. The health system-branded box did not increase response rates. This contrasts with the strong positive effects seen with text and letter interventions. Prior landmark studies in colorectal cancer screening often highlight the difficulty of reaching overdue patients. This trial confirms that low-cost behavioral interventions can effectively bridge that gap.

Clinical implications suggest that primary care practices should prioritize text reminders and mailed letters to improve screening adherence. The lack of effect from the branded box implies that packaging alone is insufficient to change behavior. Questions remain unanswered regarding long-term adherence beyond the 4-month follow-up period and the cost-effectiveness of these interventions in different healthcare systems. The absence of reported safety data limits the ability to assess potential harms, though none were observed in this trial.