Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

BackgroundScreening for colorectal cancer (CRC) with faecal immunochemical test (FIT) is effective at reducing CRC mortality. Unfortunately, the COVID-19 pandemic has been associated with deferred care, especially screening for CRC.AimWe sought to develop a mailed FIT programme (MFP) to increase CRC screening and make recommendations for adoption across the Veterans Health Administration (VHA) and for other large healthcare systems.Setting2 regional VA medical centres in California and Washington state.Participants5667 average risk veterans aged 50-75 overdue or due within 90 days for CRC screening.Programme descriptionA multidisciplinary implementation team collaborated to mail an FIT kit to eligible veterans. Both sites mailed a primer postcard, and one site added an automated reminder call.Programme evaluationWe monitored FIT return and positivity rate, as well as impact of the programme on clinical staff. 34% of FIT kits were returned within 90 days and 7.8% were abnormal.DiscussionWe successfully implemented a population-based MFP at multiple regional VA sites and recommend that these efforts be spread across VA. Our model of regional leadership, facility champions and using centralised resources can be adaptable to other large healthcare systems. MFPs support catch-up from disrupted care by addressing access to CRC screening, unburden primary care visits and conserve limited procedural resources.

Automated summary

Colorectal cancer screening with FIT is effective in reducing mortality, but has been impacted by deferred care during the COVID-19 pandemic. A mailed FIT programme was developed to increase screening rates and recommendations were made for adoption in the Veterans Health Administration and other large healthcare systems.