Tailored Telephone Counseling to Increase Adherence of Underusers in an Organized Colorectal Cancer Screening Program With FOBT: A Randomized Controlled Trial

ABSTRACT: A biennial guaiac‐based fecal occult blood test (FOBT) colorectal cancer (CRC) screening program is organized in Alsace (France) since 2003. Average risk residents aged 50‐74 are invited by mail to participate. FOBT kits are first offered by general practitioners and then mailed directly to non‐compliers. The uptake was considered insufficient in the last round, estimated between 40 and 52% depending on the geographic area. Aim: to assess whether tailored telephone counseling could increase the uptake in underusers. Methods: Never users and former users (>30 months since last FOBT) were randomized in a control group with usual recall letter and direct mailing of FOBT kits (C) and two intervention groups, using either a computer assisted telephone interview (CATI) system for tailored promotion of CRC screening, or a telephone‐based motivational interview (MI). Results: The perprotocol analysis showed that the uptake was significantly higher in both intervention groups, without significant difference between CATI (23.9%)(95% CI 21.7‐26.2) and MI (24.6%)(95% CI 22.4‐26.8)(average length, 8.2 minutes for both), than in the control group (9.7%)(95% CI 9.1‐10.3) (p<0.001). However, a minority of people could be actually reached (23.2%) and counseled (15.8%), so that the uptake was significantly higher in the control group (9.7%)(95% CI 9.1‐10.3) than in the intervention groups (4.8%)(95% CI 4.4‐ 5.1)(p<0.001) in the intent‐to‐treat analysis. The uptake was higher in former users (71.2%) than in never users (18.6%) and in people older than 60 years (28.4%) than in younger people (20.8%)(p<0.001) without significant difference between men and women (24.9% vs 23.8%) (per‐protocol analysis). Conclusions: The efficacy of tailored telephone counseling to lead underusers to participate in an organized FOBT CRC screening program is 2.5 times greater than that of a recall letter with direct mailing of FOBT kits. It is not significantly different between MI and CATI so that MI training of counselors is useless. However, telephone counseling cannot be recommended to date in France as it is neither effective nor cost‐effective because people are difficult to reach (one in four) and to counsel (two out of three people reached) by phone. Funding: Grant from the French Institut National du Cancer. (Table Presented).