Impact of Multi-Component Outreach on Colorectal Cancer Screening and Genetic Testing Preferences

Sanjay Kumar Mire ¹*, Varri Srinivasa Rao ¹

This study elucidates the critical role of outreach strategies in increasing colorectal cancer screening and genetic testing participation.

Abstract

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide, with early detection through screening significantly reducing mortality rates. However, disparities in access to screening persist, particularly in disadvantaged communities. Fecal Immunochemical Testing (FIT) offers a cost-effective, non-invasive method that increases screening participation by eliminating the need for in-person visits. Multicomponent outreach strategies are crucial to improving participation rates, particularly in populations with limited healthcare access. Methods: This study employed a mixed-method, sequential explanatory design to assess the impact of a population-based, centralized outreach program on CRC screening rates. Quantitative data from Kaiser Permanente Northern California's (KPNC) screening program were analyzed alongside qualitative ethnographic data to explore the implementation of the FIT-based outreach system. A cohort of individuals aged 51 to 75 years was included, with screening completion rates and follow-up processes examined. Results: Among the community initially screened, 40% participated in CRC screening before intervention. The implementation of a centralized, computerized outreach system led to a significant increase in participation, with screening rates rising by 30 percentage points within eight weeks. A combination of automated phone calls, text messages, and reminders during clinic visits further increased coverage by 12 percentage points, resulting in a total screening participation rate of 80%. The study also found that mailed FIT kits significantly improved participation rates, with FIT mailers leading to a 28-percentage point increase in screening compared to opportunistic testing. Various forms of patient guidance resulted in a 17-percentage point rise in screening, while recall interventions led to a modest 3-percentage point increase. Conclusion: The study demonstrates the effectiveness of a multicomponent, centralized outreach approach in increasing CRC screening participation in a large and diverse population.

Keywords: Colorectal cancer screening, Fecal Immunochemical Test (FIT), Genetic testing, Health disparities, Public health outreach

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