{"doi":"10.1016/j.cgh.2025.09.015","title":"Behavioral Interventions Improve Mailed Colorectal Cancer Screening Among Overdue Patients in a Randomized Trial","abstract":"BACKGROUND & AIMS: Mailed fecal immunochemical testing (FIT) can boost colorectal cancer screening (CRC) rates, but response rates remain limited. We evaluated if behavioral interventions increased response rates. METHODS: This pragmatic randomized trial with a 2 × 2 × 2 factorial design included primary care patients aged 50 to 74 years who were overdue for CRC screening. Patients were randomized 1:1 to receive a health system-branded blue box or a standard envelope. Patients were concurrently randomized 1:1 to receive or not receive text reminders. Patients were also concurrently randomized 1:1 to receive a reminder letter. The primary outcome was the proportion who completed a FIT within 4 months. RESULTS: Among 5244 patients included, the mean age was 59.6 years (standard deviation [SD], 7.3 years); 35.8% were Black and 53% were White. At 4 months, 17.8% (95% confidence interval [CI], 16.3%-19.2%) who received the box, compared with 18.0% (95% CI, 16.5%-19.5%) who received the standard envelope, completed FIT, an absolute difference of -0.2% (95% CI, -2.3 to 1.9%; P = .85). Among those who received text messaging, 21.2% (95% CI, 19.6%-22.8%) completed FIT compared with 14.6% (95% CI, 13.2%-15.9%) of those who did not, an absolute difference of 6.6% (95% CI, 4.6%-8.7%; P < .001). Among those that received the mailed reminder, 20.3% (95% CI, 18.7%-21.8%) completed FIT compared with 15.5% (95% CI, 14.1%-16.9%) of those who did not, an absolute difference of 4.8% (95% CI, 2.7%-6.9%; P < .001). CONCLUSIONS: Behaviorally informed text messaging and mailed reminders significantly increased screening completion, but the health system-branded box did not increase response rates. CLINICALTRIALS: gov, Number: NCT05341622.","journal":"Clinical Gastroenterology and Hepatology","year":2025,"id":528902,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":2,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9443,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT05341622"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1407162,"name":"Pranay Nadella","orcid":"0000-0003-3002-1200","position":1,"is_corresponding":false},{"id":231973,"name":"Pamela A. Shaw","orcid":"0000-0003-1883-8410","position":2,"is_corresponding":false},{"id":281587,"name":"Catherine Reitz","orcid":"0000-0002-5393-374X","position":3,"is_corresponding":false},{"id":1308419,"name":"Caitlin Brophy","orcid":null,"position":4,"is_corresponding":false},{"id":377970,"name":"Evelyn Okorie","orcid":null,"position":5,"is_corresponding":false},{"id":1256170,"name":"Keyirah Williams","orcid":null,"position":6,"is_corresponding":false},{"id":618168,"name":"Christopher K. Snider","orcid":"0000-0001-7064-4352","position":7,"is_corresponding":false},{"id":1407629,"name":"MaryAnne K Peifer","orcid":null,"position":8,"is_corresponding":false},{"id":1273373,"name":"Corinne Rhodes","orcid":"0000-0002-8773-8563","position":9,"is_corresponding":false},{"id":281593,"name":"David A. Asch","orcid":"0000-0002-7970-286X","position":10,"is_corresponding":false},{"id":281585,"name":"Shivan J. Mehta","orcid":"0000-0001-6066-4739","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T02:50:52.565868Z","pmid":"40983155","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}