Strategies to improve repeat fecal occult blood testing cancer screening

Terry C. Davis*, Connie L. Arnold, Charles L. Bennett, Michael S. Wolf, Cristalyn Reynolds, Dachao Liu, Alfred Rademaker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing. Methods: Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in eight community clinics in Louisiana. Clinics were randomly assigned to receive: enhanced care, a screening recommendation, and FOBT kit annually; a brief educational intervention where patients additionally received a literacy appropriate pamphlet and simplified FOBT instructions; or nurse support where a nurse manager provided the education and followed up with phone support. In year 2, all materials were mailed. The study consisted of 461 patients, ages 50 to 85 years, with a negative initial FOBT. Results: Repeat FOBT rates were 38% enhanced care, 33% education, and 59% with nurse support (P = 0.017). After adjusting for age, race, gender, and literacy, patients receiving nurse support were 1.46 times more likely to complete repeat FOBT screening than those receiving education [95% confidence interval (CI), 1.14-1.06; P=0.002] and 1.45 times more likely than those in enhanced care but this was not significant (95% CI, 0.93-2.26; P = 0.10). The incremental cost per additional person screened was $2,450 for nurse over enhanced care. Conclusion: A mailed pamphlet and FOBT with simplified instructions did not improve annual screening. Impact: Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT, yet this may be too costly for community clinics. Cancer Epidemiol Biomarkers Prev; 23(1); 134-43.

Original languageEnglish (US)
Pages (from-to)134-143
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Issue number1
StatePublished - Jan 2014

ASJC Scopus subject areas

  • Epidemiology
  • Oncology


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