Telehealth Intervention Can Overcome Barriers to Colorectal Screening

Personalized telephone counseling and tailored educational materials can improve colonoscopy rates among at-risk family members of patients with colorectal cancer.

Tele-Cancer Risk Assessment and Evaluation (TeleCARE) is a remote risk communication intervention that involves personalized telephone counseling and tailored print materials. A study published in the journal Cancer Epidemiology, Biomarkers & Prevention, comparing colonoscopy screening rates among at-risk relatives of patients with colorectal cancer (CRC) found that TeleCARE can improve uptake of colonoscopy irrespective of cost barriers.

The study compared the impact of TeleCARE with a mailed educational brochure on family members of CRC patients who had not been screened. Of the 481 participants who were grouped as family units, 232 were assigned to the TeleCARE group and 249 received the brochure. Those who had reported cost as a barrier to their nonadherence to screening were mailed a letter that provided details on resources for free or reduced-cost colonoscopy 9 months following either intervention. The outcome of these interventions was subsequently measured as medically verified colonoscopy rates at a 15-month follow-up.

The authors found that 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy (95% confidence interval (CI), 1.59-3.52). Nearly equal number of participants in both groups identified cost as a rate-limiting factor to screening (62.5% in TeleCARE group and 57% in educational brochure group). If cost was not a concern, participants in the TeleCARE group were almost 4 times likely to undergo a colonoscopy. When cost was a reported barrier, the TeleCARE group was nearly twice as likely to undergo colonoscopy as opposed to the comparator group. The authors therefore concluded that while TeleCARE increased colonoscopy regardless of cost barriers, the impact of the intervention was much more evident in the absence of cost concerns.

A similar study published last year in the Journal of Clinical Oncology evaluated the impact of TeleCARE in improving screening rates in relatives of CRC patients among whom their geographic location was a barrier. The interventions were similar to the current study, and the authors found that TeleCARE improved screening rates by 3-fold compared with the educational brochures. Rural residents as well as those in the lower income strata showed comparable benefit to urban residents, the authors found. They concluded that remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.