Efficacy of a telehealth intervention on colonoscopy uptake when cost is a barrier: The family CARE cluster randomized controlled trial

Laurie E. Steffen, Kenneth M. Boucher, Barbara H. Damron, Lisa M. Pappas, Scott T. Walters, Kristina G. Flores, Watcharaporn Boonyasiriwat, Sally W. Vernon, Antoinette M. Stroup, Marc D. Schwartz, Sandra L. Edwards, Wendy K. Kohlmann, Jan T. Lowery, Charles L. Wiggins, Deirdre A. Hill, John C. Higginbotham, Randall Burt, Rebecca G. Simmons, Anita Y. Kinney

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: We tested the efficacy of a remote tailored intervention Tele-Cancer Risk Assessment and Evaluation (TeleCARE) compared with a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers. Methods: Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N = 232) or an educational brochure (N = 249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained nonadherent. Rates of medically verified colonoscopy at the 15-month follow-up were compared on the basis of group assignment and within group stratification by cost barriers. Results: In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy [OR, 2.37; 95% confidence interval (CI) 1.59-3.52]. Cost was identified as a barrier in both groups (TeleCARE= 62.5%; educational brochure= 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR, 3.66; 95%CI, 1.85-7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR, 1.99; 95% CI, 1.12-3.52). Conclusions: TeleCARE increased colonoscopy regardless of cost barriers. Impact: Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent.

Original languageEnglish
Pages (from-to)1311-1318
Number of pages8
JournalCancer Epidemiology Biomarkers and Prevention
Issue number9
StatePublished - 1 Sep 2015


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