1. Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Pilot Findings from the PROMPT Study
Jamie Thompson, MPH Kaiser Permanente Center for Health Research - Northwest
Kaiser Permanente Center for Health Research

2. Topics Background Design + Methods Pilot Outcomes Conclusions
Next Steps – Main Trial

3. Background
Colon cancer is the second-leading cause of cancer death in the U.S.
Colon cancer screening rates are disproportionately low among Latinos
Community Preventive Services Task Force recommends multi- component interventions, including patient reminders, to improve uptake of colon cancer screening

4. Design + Methods What is the PROMPT study?
PROMPT = Participatory Research to Advance Colon Cancer Prevention
Five-year study
Collaboration between Kaiser, AltaMed Health Services, and OHSU
Improve rates of colon cancer screening in a Latino-serving community health center in California
OBJECTIVE: Using patient-refined materials, we examined FIT (fecal immunochemical test) completion rates following automated and live approaches in a 3-arm pilot pragmatic trial. 4

5. Study Setting: AltaMed Health Services
One of the largest FQHCs in the US
Serves almost 300,000 patients in Los Angeles and Orange Counties in Southern California
Operates 25 medical clinics
80% of patients are Latino
Los Angeles County
Orange County 5

6. Overall Study Design
Overall Study Design 6

7. Pilot Study Design Eligible participants were Intervention Latino
Ages 50 to 75 years
Not up-to-date with colon cancer screening recommendations
Had a clinic visit in each of the previous two years at either two participating health center clinics
Intervention
Automated (Group 1): A text message alert, a mailed FIT kit, and a series of two automated phone call reminders
Live (Group 2): A mailed FIT and up to three live call reminders
Auto + Live (Group 3): The combination of a text message alert, a mailed FIT, two automated call reminders, and up to three live call reminders
The interventions were delivered between 9/5/2017 – 10/20/2017.

8. Overview of Boot Camp Translation Process
Format and content of alerts and reminders were selected using a validated patient- engagement approach called boot camp translation conducted between May and July 2017. 8

9. English Language Session Spanish Language Session
Who Participated in Boot Camp Translation?
English Language Session
Spanish Language Session
Number of participants (in-person meeting) 12 13
Number of patients 10 11
Number of clinic staff 2
PATIENTS ONLY
Age (years), mean
57.1
56.6
Female, % 60 91
Latino, % 80
100
Medicaid, % 36
Uninsured, %
Annual household income less than $20,000, % 50 82
Less than high school education, % 20 73
Born outside of the United States, % 9

10. Products
Drafted based on in-person meeting and refined using iterative phone conversations
Final Materials:
What/Mode
Timing
Text Message Alert
Before
Auto Call Reminder Message
After
Live Call Reminder Script
Intro Letter
With Kit
1-Page Educational Fact Sheet
Final materials are available at 10

11. Automated Phone Call Reminder
Text Message Alert
AltaMed is mailing you a free colon health test to do at home.
Complete the test - it could save your life!
Questions? Call
Automated Phone Call Reminder
Hello [INSERT Patient First Name], I am calling from AltaMed to remind you to complete the free colon health test we sent you. Take control of your health and complete the test today. You and your family will be happy you did!
If patient answers: To speak with an AltaMed staff member, please press 0.
If voic is reached: If you have questions about the test, please call us at 11

12. Letter with FIT Kit Mailing12

13. 1-Page Educational Fact Sheet13

14. Pilot Outcomes
Among randomized participants (n=1,767), 553 (31.3%) completed a FIT within 6 months. 14

15. Pilot Outcomes (continued)
Female
Latino
Spanish-Speaking
Uninsured
Missed Appointment
57%
83%
59%
25%
66% 15

16. Pilot Outcomes (continued)
In bivariate comparisons, FIT completion rates differed significantly by:
Preferred language (p < .01)
English: 25.5%
Spanish: 35.1%
Other: 39.7%
Number of clinic visits in the past year (p < .01)
At least one: 33.9%
None: 1.2%
Prior FIT testing (p < .01)
Yes: 45.1%
No: 17.1% 16

17. Pilot Outcomes (continued)
Adjusted difference and associated 95% confidence intervals between intervention groups:
Controlling for clinic, adults allocated to the live condition had a significantly higher FIT completion rate than those in the automated condition. 17

18. Conclusions
Live phone call reminders, either alone or in combination with automated alerts and reminders, outperformed automated approaches alone.
Using multiple touchpoints and communication modes might have the greatest impact on FIT completion rates. 18

19. Next Steps
Main Trial
Patients who have never completed a FIT, have not had a recent clinic visit, or speak English may benefit from in- person or phone-based discussions about the importance of colon cancer screening.
To boost screening in the group that has never completed a FIT, future work will test the effectiveness of live phone calls delivered before a FIT is mailed.
Conduct budget impact analysis 19

20. Acknowledgements Kaiser Center for Health Research
Gloria Coronado, PhD
Michael Leo, PhD
David Smith, PhD
Jennifer Schneider, MS
Amanda Petrik, MS
Sacha Reich, MS
Jennifer Rivelli, MA
Jamie Thompson, MPH
Analyst: Denis Nyongesa
Graphics: Lisa Fox, Alex Wijnen-Hannon
Oregon Health & Science University
Melinda Davis, PhD
LeAnn Michaels, BS
AltaMed Health Services
Alex Chen, MD
Anne Escaron, PhD
Melissa Castillo, MSW
Brittany Younger, MSW
Marta Castro, BA
Funding is provided by the National Institutes of Minority Health and Health Disparities 20

21. Thank you! Questions? Jamie Thompson, MPH Project Director, PROMPT
Kaiser Permanente Center for Health Research
Portland, OR
Phone: (503) 21