Telephone Patient Outreach Messaging More Effective Than Mailers

Healthcare organizations deploying patient outreach messaging for preventive care screenings should consider personalizing those messages to patient preferences and characteristics, concluded a group of researchers from Penn Medicine.

Mainly, tailored patient outreach messaging over the telephone was better than generic messaging over the phone or mailed patient outreach, the group wrote in JAMA Network Open.

These findings come as healthcare organizations work to get patients back into the office for their routine screenings. The COVID-19 pandemic dissuaded many patients from accessing preventive care, either because their provider offices rescheduled their appointments or because they became fearful of contracting the virus in the clinic or office.

Emerging evidence is showing that deferred care is leading to later-stage cancer diagnosis, which with it comes a grimmer prognosis. Primary care providers are working to ameliorate that problem through better patient outreach, reminding patients and encouraging them to come in for routine screenings.

This data offers some insights into the patient outreach messaging that works best. In a comparative analysis of 600 patients ages 50 to 75 who were eligible but not scheduled for a routine colonoscopy, the researchers determined that tailored patient outreach messaging was the most effective over the telephone.

Researchers grouped patients into three research cohorts, including usually care, which entailed a mailed letter encouraging colonoscopy scheduling; telephone patient outreach, which included a patient assessment and generic messaging; and tailored telephone patient outreach, which included a phone call, assessment, and tailored outreach that accounted for the original assessment.

Telephone patient outreach messaging prevailed as the best form of patient engagement, the researchers found. While just over a quarter of those in the usual care group receiving outreach letters scheduled a colonoscopy within 120 days of receipt, more than half of those getting phone calls did the same. Tailored phone call messaging was slightly more effective, with 53 percent of patients scheduling an appointment; 52.5 percent of those getting generic phone messages scheduled an appointment.

Moreover, patients getting telephone outreach had a higher colonoscopy completion rate. About a third of patients getting a phone call ended up getting a colonoscopy, with 34.5 percent in the tailored messaging group and 32 percent in the generic messaging group following through. Only 18.5 percent of those in the usual care group wound up getting their colonoscopy.

The researchers acknowledged that there wasn’t a huge difference between patients getting tailored or generic messages over the phone.

“Speaking on the phone with dedicated research staff and completing the assessment may have increased participants’ motivation to participate in CRC screening, independent of delivery of a tailored message,” they posited.

In the future, research should control for those assessments to measure the true effect of a tailored patient outreach message, the researchers recommended.

Healthcare organizations will need to do more than just implement patient outreach messaging, too, the researchers said. About a third of those who scheduled a colonoscopy did not end up getting one, something that could be credited to some key social determinants of health barring patient access to care, like timely access to care, cost, transportation, limited patient education about procedure preparation, and changes in health status.

“The discrepancy between colonoscopy scheduling rates and colonoscopy completion rates calls attention to the need for complementary interventions, such as patient navigation assistance, to ensure that scheduled patients actually obtain their colonoscopy in a timely manner,” the researchers wrote. “The effect of health communication interventions on [colorectal cancer] screening rates will be limited if patients cannot easily access their screening test of choice after referral.”

Understanding strategies for patient re-engagement has been critical the past two years. In March 2022, researchers from the Prevent Cancer Foundation reported that 50 percent of Americans had an in-person medical appointment during the pandemic that they missed, delayed, or canceled.

That delayed care has had disastrous impacts, the American Association for Cancer Research (AACR) reported. An estimated 10 million cancer diagnoses were missed during the first few months of the pandemic, which may have led to worse prognoses. Early cancer detection is essential to good outcomes, experts agree, and the decline in cancer detection could spell bad news for patients.

In addition to telephone patient outreach messaging, researchers have identified patient-provider communication and shared decision-making as effective. Researchers wrote in Mayo Clinic Proceedings that taking into account both patient risk and patient preferences could compel more patients to get some type of colorectal cancer screening.

Particularly, providers who find a patient at average or low risk for colorectal cancer may determine a stool sample to be the best option and see higher rates of patient follow-through. The best test a patient can get is the one she will actually access, the researchers agreed, suggesting it’s best to decide with patients how to screen for certain illnesses.