February 23, 2018: Direct Mail Programs Work… But Will Health Centers Implement Them? Findings from STOP CRC


Gloria D. Coronado, PhD
Senior Investigator
Mitch Greenlick Endowed Scientist for Health Disparities
Kaiser Permanente Center for Health Research

Beverly B. Green, MD, MPH
Associate Investigator
Kaiser Permanente Washington Health Research Institute


Direct Mail Programs Work… But Will Health Centers Implement Them? Findings from STOP CRC


Pragmatic clinical trial; STOP CRC; Colorectal cancer; Direct mail; Clinical research

Key Points

  • Strategies and Opportunites to Stop Colorectal Cancer in Priority Populations (STOP CRC) looked at the effect of direct mail fecal testing for patients due for colorectal cancer screening.
  • Kaiser Permanente’s Thrive program mails more than 500,000 test kits annually, with over 60% completed and returned.
  • In STOP CRC, a cluster-randomized pragmatic trial, researchers identified eligible patients for each of three intervention steps: an introduction letter, a testing kit, and a reminder postcard.
  • Completion of colorectal cancer screening was higher in intervention groups than usual care, in both primary and lagged datasets, with the highest rates seen in clinics that sent reminder cards.

Discussion Themes

A lagged data set was an ad hoc addition when the researchers realized that many clinics faced delays and what looked like Year 2 screenings were actually Year 1.

Findings from STOP CRC confirm the major challenge of bridging the gap between efficacy studies and effectiveness studies.

In reflecting on implementation, a second pilot might have helped ensure that sites were properly equipped to handle the requirements of mass printing and mailing needed for test kits.


For information on STOP CRC, visit The Living Textbook http://bit.ly/2GBD1VB


@PCTGrandRounds, @kpthrive, #colorectalcancer, #pragmatictrials, #pctGR