Year of Publication

2018

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Bin Huang

Committee Member

Dr. Richard Kryscio

Committee Member

Dr. Angela Carman

Committee Member

Dr. Robin Vanderpool

Abstract

Colorectal cancer is the second leading cause of cancer-related death in this country, but 33% of these deaths could be prevented by screening. While colonoscopy is an effective screening tool, it is expensive, invasive, and prone to encounter considerable patient resistance. An alternative is to first screen those at-risk using at-home fecal immunochemical test (FIT) kits. This study determined factors associated with the return of these kits distributed by Kentucky CancerLink, a non-profit organization, and its affiliates to participants in a colon cancer prevention program.

Objectives: To identify factors associated with: completing a FIT kit, completing the kit with minimal prompting, a positive FIT kit result, and a positive colonoscopy result. To evaluate a colon cancer screening program for internal and Commission on Cancer (CoC) implementation goals: ship kits promptly; notify patients and their physician, if requested, of FIT results promptly; follow-up on positive FIT results; encourage a high percentage of patients with a positive FIT to complete physician recommended follow-up; and evaluate effectiveness of follow-up contact policy.

Design: Descriptive

Setting: Non-profit organization in central Kentucky

Participants: The study analyzed data collected on 436 FIT kit participants, and 17 direct to colonoscopy participants, during the period January 1 through October 30, 2016. Participants were eligible if over 45 and African American or over 50 for all other races or family history of early-onset colon cancer or precancerous condition, Kentucky resident, and no history of colonoscopy in the past 5 years.

Outcome measures: FIT kit return, return of the FIT kit with 0-2 follow-up calls, FIT kit result, colonoscopy result, percentage of FIT kits shipped to participants in 0-2 business days, percentage of patients notified of FIT results in 0-2 business days, percentage of physicians notified in 0-2 business days, percentage of patients with positive FIT followed, percentage of patients with positive FIT who completed follow-up, number of calls and last attempt letters.

Results: Participants over 60 years of age had higher return rates than those under 60. Participants recruited via advertising, physician referrals, or health fairs had better return rates than participants recruited via church, work, or cold calls. Men were more likely than women to promptly return their kits. Caucasian: non- Hispanics were more likely to have a positive FIT result than African American or Hispanic & Other ethnicities. Participants referred by physician cold call list or advertising were more likely to have a positive FIT than those recruited via physician referrals, health fairs, church, or work. Participants directly referred to colonoscopy were more likely to have a positive finding on colonoscopy than those who had a positive FIT kit. The program met its goals statistically of shipping kits promptly and following up on positive FIT results. A policy of 3 follow-up calls and a last attempt letter was successful in encouraging the majority of participants to complete their kits.

Conclusions: While this study involved a relatively small sample size and cannot be generalized to a larger population, the value of evaluating a screening program, learning which methods of recruitment bear more fruit than others, and using that information can be generalized to other organizations, no matter the size of the program. Patient navigators encouraged 73.62% of participants to complete their FIT kits through the use of follow-up calls and last attempt letters. Adults at greater risk of colon cancer responded well to the program. Adults over 60 were more likely to complete their kit. Men were more likely to complete their kit with minimal prompting. Patients who were screened directly to colonoscopy were more likely to have positive colonoscopy result. The program met its internal and CoC guidelines. These findings inform public health officials on how to allocate resources to maximize return of FIT kits in a colon cancer prevention program. Future programs would do well to recognize that participants themselves were still the rate limiting step, so patient navigators should put the kits in the hands of at risk people, and remind them.

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