Reminders to patients boosted colon cancer screening rates

Reminders mailed to patients who were overdue for colorectal cancer screening tests were more effective than sending alerts to their doctors during office visits, a Boston study has found.

Because only about 60 percent of patients nationwide say they are up to date on colorectal screening, researchers led by Dr. Thomas D. Sequist of Brigham and Women's Hospital tested ways to bring patients in for the tests. They report their results in this week's Archives of Internal Medicine.

National guidelines recommend people 50 and older be screened for colorectal cancer, which is the second leading cause of cancer deaths, after lung cancer. Colonoscopy can reduce colorectal cancer deaths by removing precancerous growths or detecting cancer at a more curable stage.

In the study, which was funded by the National Cancer Institute, more than 21,000 patients and 110 primary care physicians at Harvard Vanguard Medical Associates were randomly assigned to get notices saying the patients hadn't been screened for colorectal cancer. Some patients were also sent personalized reminders.

Patients who received the personalized mailings were significantly more likely -- 44 percent vs. 38 percent -- to get their screening tests done than similar patients who did not get the mailings. But patients whose doctors got electronic reminders during office visits were not more likely, statistically speaking -- 41.9 percent vs. 40.2 percent -- to get screened than patients whose doctors did not get the reminders.

Doctors tended to order more screening tests when reminded to do so only if their patients had at least three visits during the study's 18-month period. And patients over 60 were more likely to schedule the tests after getting mailed reminders than patients in their 50s.

"The modest effect of patient reminders in our study suggests the need to develop more effective strategies to actively engage these [unscreened] patients and encourage them to be screened for colorectal cancer," the authors write. "However, the clear advantage of patient involvement over physician reminders in our study suggests that future strategies should increasingly involve patient-based activity."