Improving Colorectal Cancer Screening in a Rural Setting: A Randomized Study

Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings. RCT. Adults (n=7,812) aged 50–75 years and due for colorectal cancer screening in a largely rural health system were randomly assigned to either the intervention (n=3,906) or the control (n=3,906) group in September 2016, with analysis following through 2018. A mailed motivational messaging screening reminder letter with an option to call and request a free at-home fecal immunochemical screening test (intervention) or the standard invitation letter detailing that the individual was due for screening (control). Multifaceted motivational messaging emphasized colorectal cancer preventability and the ease and affordability of screening, and communicated a limited supply of test kits. Colorectal cancer screening participation within 6 months after mailed invitation was ascertained from the electronic medical record. Colorectal cancer screening participation was significantly improved in the intervention (30.1%) vs the usual care control group (22.5%; p