S617 Reaching the Unscreened: Adherence Outcomes From an mt-sDNA CRC Screening Care Gap Program

Introduction: Adherence to annual stool-based tests for colorectal cancer (CRC) screening, including fecal immunochemical tests (FIT) or fecal occult blood tests (FOBT), is frequently suboptimal. Multi-target stool DNA (mt-sDNA) testing has shown promise at improving adherence rates due to its ease of use, built-in care navigation and longer recommended 3-year screening interval. This study aimed to evaluate CRC screening adherence within a gap closure program that shipped mt-sDNA kits to individuals who were due or overdue for screening and without a point-of-care test order from their provider. We compared adherence between patients who previously completed mt-sDNA testing and those who had used other non-invasive modalities (ONIM). Methods: A gap closure program was third-party implemented to improve CRC screening adherence among Medicare Advantage enrollees aged 50 to 75 years who were due or overdue for repeat screening. Mt-sDNA tests were shipped to patients who had previously screened for CRC with mt-sDNA or ONIM. Adherence was defined as return and successful resulting of an mt-sDNA kit within 120 days of shipment. Logistic regression analysis was conducted to identify characteristics associated with screening adherence. Results: The study population included 2,095 individuals with a history of mt-sDNA use and 24,805 individuals who previously used ONIM for CRC screening. The gap closure program demonstrated strong effectiveness, bringing 53.4% of prior mt-sDNA users and 38.8% of ONIM users up to date with recommended screening. In multivariable logistic regression analysis, prior mt-sDNA users were significantly more likely to adhere to the program compared to ONIM users (odds ratio [OR] 1.74; 95% CI, 1.58–1.91). Older age (65–75 vs 50–64 years; OR 1.86; 95% CI, 1.76–1.97) and opting to receive digital communications (email and text vs no digital communication; OR 2.29; 95% CI, 2.09–2.51) were also strong adherence predictors. Conclusion: A targeted gap closure program achieved promising mt-sDNA CRC rescreening adherence among both ONIM and prior mt-sDNA users. These results are significant as this population may be challenging to reach due to many being overdue for screening and potentially not regularly visiting their provider to obtain an in-person point-of-care test order. Prior screening behavior, age, and digital communication were key predictors of adherence. Notably, the repeat mt-sDNA adherence rates in this study exceed those historically reported for repeat FIT screening.