Department of Research & Evaluation News

A study among Kaiser Permanente members in Southern California shows that allowing patients to self-order a colorectal cancer screening test online improves rates of testing completion. The rates of both completion and follow-up activities were higher among patients who ordered the tests themselves than those who received the test kit automatically in the mail when it was due, per the usual process.

The research was published today in the Journal of General Internal Medicine.

“The colorectal cancer screening rates among Kaiser Permanente members in Southern California are already over 80% due to dedicated efforts by our clinical and operational teams,” said lead researcher Erin Hahn, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation. “However, we are always striving to improve, and we found that offering self-ordering on our secure kp.org website seemed to increase a patient’s commitment to taking and sending in the test. This was very gratifying because we know these tests can save lives.”

Colorectal cancer is one of the leading causes of cancer-related death in the United States, with more than 50,000 deaths estimated in 2019. If we can increase our colorectal cancer screening rates even by a little, we could have an enormous impact on reducing colorectal cancer mortality, Dr. Hahn said.

In the study, researchers evaluated the interactive interface on the kp.org website that allowed patients who were due for an at-home colorectal cancer screening kit to self-order — in this case fecal immunochemical test kits — with the click of a button. For those who did not self-order online, kits were automatically mailed to them when they were due to take the test.

Kaiser Permanente recommends annual at-home colorectal cancer screening for patients between the ages of 50 and 74 years of age, who have had no history of colorectal cancer, have not completed colorectal cancer screening within the past 12 months, and have not completed a colonoscopy within the past 10 years, or sigmoidoscopy within the past 5 years.

The study cohort included 176,231 participants between 50 and 74 years of age who were eligible for colorectal cancer screening. It found:

• Approximately 10% of participants (16,918 in total) used the self-order function on the kp.org website to order an at-home test kit for colorectal cancer.
• Those who used the self-order function were 3.8 times more likely to complete the kit compared to participants who were sent a kit automatically.
• Within the self-ordering group, 63% of those eligible completed a colorectal screening test in the year prior to the button compared to 87% in the year after the button became available.
• The mean number of days that patients took to complete a test was 56 in the group that used the self-order option, compared to 90 days in the group that was automatically mailed the test.
• Overall, 4% of those in both groups who completed a test required additional screening for positive or inconclusive results. Of those patients who had a positive result requiring additional screening, 8% of those who used the button to order a test did not have subsequent recommended screening vs. 18% in group that did not use the button.

“Based on these results, we see that it is possible that the self-order option can act as an effective commitment device,” Dr. Hahn said. “This may be the case even for patients who had not previously completed a colorectal screening test.”