No-cost envelope modification improves fecal immunochemical test laboratory acceptance in a US Veterans Affairs colorectal cancer screening trial

Fecal immunochemical testing (FIT) screens for colorectal cancer (CRC) through detection of hemoglobin. Specimens without a collection date are a common source of test cancellation. We implemented a quality improvement intervention to improve collection date documentation and screening completion using a pre–post design. Within a large US Veterans Affairs (VA) CRC screening trial, we modified the FIT return envelope instructions, including a field for collection date documentation on the envelope. Preintervention 6654/7083 FIT kits (93.9%) were received with a collection date compared to 3069/3105 (98.8%) postintervention ( p < .00001). Preintervention, 35.2% of kits without a date were received within 15 days of original outbound mailing of the kit from VA, thereby allowing testing in 95.4% of all kits received. Postintervention, 44.4% of undated kits were received within 15 days of mailing from the VA, allowing for testing of 98.8% of all kits ( p < .00001 compared to preintervention). The intervention was associated with an absolute 3.5% (95% CI: 2.8%–4.1%) increase in testable kits, thereby reducing the proportion of individuals requiring retesting from 4.6% to 1.2%. This no-cost, targeted intervention was associated with a significantly increased proportion of individuals successfully completing screening. Programs using FIT should consider implementation of this no-cost intervention to enhance program effectiveness.