Increasing Uptake of Colorectal Cancer Screening in Ontario

Sunnybrook Health Sciences Centre5,155 enrolled

Overview

The investigators hope to determine whether the addition of an FOBT kit and educational materials to a second mailed invitation compared to a second mailed invitation alone increases use of appropriate screening tests (FOBT for average risk or colonoscopy if increased risk) by eligible persons within 6 months of the second mailing in: (1)Non-responders to an initial mailed CRC screening invitation from their family physician and, (2)Those who responded to the initial mailed CRC screening invitation and are due for repeat screening (i.e., "recall" patients). In addition, the investigators will also explore the impact of the investigators intervention in likely under-screened groups such as those living in more remote areas of the province and those with low socio-economic status as well as assessing the cost-effectiveness of this strategy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SCREENING

Masking

SINGLE

Enrollment

5,155

Conditions

Colorectal Disorders

Interventions

Eligibility

Sex: ALLMin age: 50 YearsMax age: 74 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Recipients of a mailed CRC screening invitation through the CCO Invitation Pilot project * No OHIP record of completion of FOBT since initial mailing (Non-responders arm only) * No OHIP of 'CRC Cancer Screening Exclusion' tracking code since initial mailing (Non-responders arm only) * An OHIP record of completion of FOBT 6 months since initial mailing (Recall arm only) * Negative result according to LRT or if not in LRT, no record of interval colonoscopy in CIRT or OHIP (Recall arm only) Exclusion Criteria: * Age greater than 74 years at time of mailing * Interval diagnosis of colorectal cancer * Interval colonoscopy or flexible sigmoidoscopy * Interval departure from Pilot physician's practice * Death * Presently institutionalized * Physician has declined participation in the study * Interval record of repeat FOBT (Recall arm only)

Outcomes

Primary Outcomes

Uptake of appropriate CRC screening

The primary outcome will be the uptake of appropriate screening (FOBT testing or if there is a positive family history, of colonoscopy) within 6 months of the mailing as determined by from OHIP and CCO data.

Time frame: Within 6 months of the mailing

Secondary Outcomes

Uptake of lower gastrointestinal investigations

The secondary outcome will be the uptake of lower gastrointestinal investigations (colonoscopy for an indication other than family history or colonoscopy done outside of CIRT, flexible sigmoidoscopy, barium enema) within 12 months, respectively, of the mailing as determined by the administrative data (CIRT, OHIP procedure or radiology code).

Time frame: Within 12 months of the mailing