A Postcard Primer Prior to Mailed Fecal Immunochemical Test Among Veterans: a Randomized Controlled Trial

Background Mailed fecal immunochemical testing (FIT) programs are increasingly utilized for population-based colorectal cancer (CRC) screening. Advanced notifications (primers) are one behavioral designed feature of many mailed FIT programs, but few have tested this feature among Veterans. Objective To determine if an advanced notification, a primer postcard, increases completion of FIT among Veterans. Design This is a prospective, randomized quality improvement trial to evaluate a postcard primer prior to a mailed FIT versus mailed FIT alone. Participants A total of 2404 Veterans enrolled for care at a large VA site that were due for average-risk CRC screening. Intervention A written postcard sent 2 weeks in advance of a mailed FIT kit that contained information on CRC screening and completing a FIT. Main Measures Our primary outcome was FIT completion at 90 days, and our secondary outcome was FIT completion at 180 days. Key Results Overall, unadjusted mailed FIT return rates were similar among control vs. primer arms at 90 days (27% vs. 29%, p = 0.11). Our adjusted analysis found a primer postcard did not increase FIT completion compared to mailed FIT alone (OR 1.14 (0.94, 1.37)). Conclusions Though primers are often a standard part of mailed FIT programs, we did not find an increase in FIT completion with mailed postcard primers among Veterans. Given the overall low mailed FIT return rates, testing different ways to improve return rates is essential to improving CRC screening.