Increasing colorectal cancer screening in an overdue population: Participation and cost impacts of adding telephone calls to a fit mailing program

Jennifer A. Schlichting, Michelle A. Mengeling, Nader M. Makki, Ashish Malhotra, Thorvardur R. Halfdanarson, J. Stacey Klutts, Barcey T. Levy, Peter J. Kaboli, Mary E. Charlton

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned (27.43 vs. 44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.

Original languageEnglish (US)
Pages (from-to)239-247
Number of pages9
JournalJournal of Community Health
Issue number2
StatePublished - Apr 2014

Bibliographical note

Funding Information:
Acknowledgments The authors would like to thank Stacy Wittrock and Ashley Cozad for their efforts in coordinating this study. We would also like to acknowledge Lindsey Davenport-Landry in the Iowa City VA laboratory for her work in managing all of the laboratory aspects of this project. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR), and the VA Health Services Research and Development (HSR&D) Service, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) (CIN 13–412). The views expressed in this article are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the United States Government.


  • Colorectal cancer screening
  • Cost comparison
  • Fecal immunochemical test
  • Intervention


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