Screening initiation with FIT or colonoscopy: Post-hoc analysis of a pragmatic, randomized trial

Caitlin Claffey Murphy, Chul Ahn, Sandi Pruitt, Amy E. Hughes, Ethan A Halm, Samir Gupta, Noel O. Santini, Katharine McCallister, Joanne M. Sanders, Amit Singal, Celette S Skinner

Research output: Contribution to journalArticle

Abstract

Screening with FIT or colonoscopy can reduce CRC mortality. In our pragmatic, randomized trial of screening outreach over three years, patients annually received mailed FITs or colonoscopy invitations. We examined screening initiation after each mailing and crossover from the invited to other modality. Eligible patients (50–64 years, ≥1 primary-care visit before randomization, and no history of CRC) received mailed FIT kits (n = 2400) or colonoscopy invitations (n = 2400) from March 2013 through July 2016. Among those invited for colonoscopy, we used multinomial logistic regression to identify factors associated with screening initiation with colonoscopy vs. FIT vs. no screening after the first mailing. Most patients were female (61.8%) and Hispanic (48.9%) or non-Hispanic black (24.0%). Among those invited for FIT, 56.6% (n = 1359) initiated with FIT, whereas 3.3% (n = 78) crossed over to colonoscopy; 151 (15.7%) and 61 (7.7%) initiated with FIT after second and third mailings. Among those invited for colonoscopy, 25.5% (n = 613) initiated with colonoscopy whereas 18.8% (n = 452) crossed over to FIT; 112 (8.4%) and 48 (4.2%) initiated with colonoscopy after second and third mailings. Three or more primary-care visits prior to randomization were associated with initiating with colonoscopy (OR 1.49, 95% CI 1.17–1.91) and crossing over to FIT (OR 1.63, 95% CI 1.19–2.23). Although nearly half of patients initiated screening after the first mailing, few non-responders in either outreach group initiated after a second or third mailing. More patients invited to colonoscopy crossed over to FIT than those assigned to FIT crossed over to colonoscopy.

Original languageEnglish (US)
Pages (from-to)332-335
Number of pages4
JournalPreventive Medicine
Volume118
DOIs
StatePublished - Jan 1 2019

Fingerprint

Pragmatic Clinical Trials
Colonoscopy
Random Allocation
Primary Health Care
Hispanic Americans

Keywords

  • Colorectal neoplasms
  • Health promotion
  • Mass screening
  • Pragmatic clinical trial
  • Safety-net providers

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Screening initiation with FIT or colonoscopy : Post-hoc analysis of a pragmatic, randomized trial. / Murphy, Caitlin Claffey; Ahn, Chul; Pruitt, Sandi; Hughes, Amy E.; Halm, Ethan A; Gupta, Samir; Santini, Noel O.; McCallister, Katharine; Sanders, Joanne M.; Singal, Amit; Skinner, Celette S.

In: Preventive Medicine, Vol. 118, 01.01.2019, p. 332-335.

Research output: Contribution to journalArticle

@article{2b270deeb1a9425ead1258b9ae779515,
title = "Screening initiation with FIT or colonoscopy: Post-hoc analysis of a pragmatic, randomized trial",
abstract = "Screening with FIT or colonoscopy can reduce CRC mortality. In our pragmatic, randomized trial of screening outreach over three years, patients annually received mailed FITs or colonoscopy invitations. We examined screening initiation after each mailing and crossover from the invited to other modality. Eligible patients (50–64 years, ≥1 primary-care visit before randomization, and no history of CRC) received mailed FIT kits (n = 2400) or colonoscopy invitations (n = 2400) from March 2013 through July 2016. Among those invited for colonoscopy, we used multinomial logistic regression to identify factors associated with screening initiation with colonoscopy vs. FIT vs. no screening after the first mailing. Most patients were female (61.8{\%}) and Hispanic (48.9{\%}) or non-Hispanic black (24.0{\%}). Among those invited for FIT, 56.6{\%} (n = 1359) initiated with FIT, whereas 3.3{\%} (n = 78) crossed over to colonoscopy; 151 (15.7{\%}) and 61 (7.7{\%}) initiated with FIT after second and third mailings. Among those invited for colonoscopy, 25.5{\%} (n = 613) initiated with colonoscopy whereas 18.8{\%} (n = 452) crossed over to FIT; 112 (8.4{\%}) and 48 (4.2{\%}) initiated with colonoscopy after second and third mailings. Three or more primary-care visits prior to randomization were associated with initiating with colonoscopy (OR 1.49, 95{\%} CI 1.17–1.91) and crossing over to FIT (OR 1.63, 95{\%} CI 1.19–2.23). Although nearly half of patients initiated screening after the first mailing, few non-responders in either outreach group initiated after a second or third mailing. More patients invited to colonoscopy crossed over to FIT than those assigned to FIT crossed over to colonoscopy.",
keywords = "Colorectal neoplasms, Health promotion, Mass screening, Pragmatic clinical trial, Safety-net providers",
author = "Murphy, {Caitlin Claffey} and Chul Ahn and Sandi Pruitt and Hughes, {Amy E.} and Halm, {Ethan A} and Samir Gupta and Santini, {Noel O.} and Katharine McCallister and Sanders, {Joanne M.} and Amit Singal and Skinner, {Celette S}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ypmed.2018.11.020",
language = "English (US)",
volume = "118",
pages = "332--335",
journal = "Preventive Medicine",
issn = "0091-7435",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Screening initiation with FIT or colonoscopy

T2 - Post-hoc analysis of a pragmatic, randomized trial

AU - Murphy, Caitlin Claffey

AU - Ahn, Chul

AU - Pruitt, Sandi

AU - Hughes, Amy E.

AU - Halm, Ethan A

AU - Gupta, Samir

AU - Santini, Noel O.

AU - McCallister, Katharine

AU - Sanders, Joanne M.

AU - Singal, Amit

AU - Skinner, Celette S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Screening with FIT or colonoscopy can reduce CRC mortality. In our pragmatic, randomized trial of screening outreach over three years, patients annually received mailed FITs or colonoscopy invitations. We examined screening initiation after each mailing and crossover from the invited to other modality. Eligible patients (50–64 years, ≥1 primary-care visit before randomization, and no history of CRC) received mailed FIT kits (n = 2400) or colonoscopy invitations (n = 2400) from March 2013 through July 2016. Among those invited for colonoscopy, we used multinomial logistic regression to identify factors associated with screening initiation with colonoscopy vs. FIT vs. no screening after the first mailing. Most patients were female (61.8%) and Hispanic (48.9%) or non-Hispanic black (24.0%). Among those invited for FIT, 56.6% (n = 1359) initiated with FIT, whereas 3.3% (n = 78) crossed over to colonoscopy; 151 (15.7%) and 61 (7.7%) initiated with FIT after second and third mailings. Among those invited for colonoscopy, 25.5% (n = 613) initiated with colonoscopy whereas 18.8% (n = 452) crossed over to FIT; 112 (8.4%) and 48 (4.2%) initiated with colonoscopy after second and third mailings. Three or more primary-care visits prior to randomization were associated with initiating with colonoscopy (OR 1.49, 95% CI 1.17–1.91) and crossing over to FIT (OR 1.63, 95% CI 1.19–2.23). Although nearly half of patients initiated screening after the first mailing, few non-responders in either outreach group initiated after a second or third mailing. More patients invited to colonoscopy crossed over to FIT than those assigned to FIT crossed over to colonoscopy.

AB - Screening with FIT or colonoscopy can reduce CRC mortality. In our pragmatic, randomized trial of screening outreach over three years, patients annually received mailed FITs or colonoscopy invitations. We examined screening initiation after each mailing and crossover from the invited to other modality. Eligible patients (50–64 years, ≥1 primary-care visit before randomization, and no history of CRC) received mailed FIT kits (n = 2400) or colonoscopy invitations (n = 2400) from March 2013 through July 2016. Among those invited for colonoscopy, we used multinomial logistic regression to identify factors associated with screening initiation with colonoscopy vs. FIT vs. no screening after the first mailing. Most patients were female (61.8%) and Hispanic (48.9%) or non-Hispanic black (24.0%). Among those invited for FIT, 56.6% (n = 1359) initiated with FIT, whereas 3.3% (n = 78) crossed over to colonoscopy; 151 (15.7%) and 61 (7.7%) initiated with FIT after second and third mailings. Among those invited for colonoscopy, 25.5% (n = 613) initiated with colonoscopy whereas 18.8% (n = 452) crossed over to FIT; 112 (8.4%) and 48 (4.2%) initiated with colonoscopy after second and third mailings. Three or more primary-care visits prior to randomization were associated with initiating with colonoscopy (OR 1.49, 95% CI 1.17–1.91) and crossing over to FIT (OR 1.63, 95% CI 1.19–2.23). Although nearly half of patients initiated screening after the first mailing, few non-responders in either outreach group initiated after a second or third mailing. More patients invited to colonoscopy crossed over to FIT than those assigned to FIT crossed over to colonoscopy.

KW - Colorectal neoplasms

KW - Health promotion

KW - Mass screening

KW - Pragmatic clinical trial

KW - Safety-net providers

UR - http://www.scopus.com/inward/record.url?scp=85057785145&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057785145&partnerID=8YFLogxK

U2 - 10.1016/j.ypmed.2018.11.020

DO - 10.1016/j.ypmed.2018.11.020

M3 - Article

C2 - 30508552

AN - SCOPUS:85057785145

VL - 118

SP - 332

EP - 335

JO - Preventive Medicine

JF - Preventive Medicine

SN - 0091-7435

ER -