Text Messaging and Opt-out Mailed Outreach in Colorectal Cancer Screening: a Randomized Clinical Trial

Regular participation in screening effectively reduces the risk of dying from colorectal cancer (CRC), however,  national screening rates in the US fall below national targets. This study focused on an underserved population and compared the effectiveness of a single text message screening reminder as per usual practice to a pre-alert text message offering the options to opt-out of receiving a mailed fecal immunochemical test (FIT) kit, followed by up to three behaviorally informed text message reminders. They found that at 12 weeks, there was an absolute 17.3 percentage point increase in colorectal cancer screening in the intervention arm (19.6%), compared to the control arm (2.3%). Furthermore, there was an absolute 17.7 percentage point increase in FIT kit return in the intervention arm (19.1%) compared to the control arm (1.4%). This shows that cancer screening strategies cannot rely solely on the availability of effective cancer screening tests; this also requires effective patient engagement.

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