Abstract
Introduction: The relative dearth of financial and human resources in rural areas complicates the delivery of timely medical expertise and treatment to its inhabitants. Travel distances between patients and their providers pose transportation barriers that contribute to low colorectal cancer screening rates in rural areas. Increasing applications of telemedicine technologies in health care may reduce or mitigate problems associated with transportation and insufficient availability of local providers. The objective of this study was to conduct a scoping review to compare types of telemedicine interventions for colorectal cancer screening in rural areas to those that have been studied more broadly, evaluate the quality of existing evidence, and suggest opportune areas for further investigation and application.
Methods: Searches were conducted in Ovid Medline, EMBASE, and Cochrane databases with the guidance of a librarian. We included peer-reviewed full text articles in English and Spanish about telemedicine interventions in CRC screening. Telemedicine interventions for CRC screening were operationally defined as the use of telephone and Internet-based technologies to aid patient decision making, reduce transportation barriers, and circumvent lack of local human resources from the first moment of screening awareness through cancer diagnosis. We did not exclude articles based on study design type. Risk of bias was assessed through measures including randomization, blinding, and incomplete outcome reporting. Quality was defined by factors such as risk of bias and representativeness of sampled populations.
Results: Of 2223 non-duplicate studies, 167 articles fell into the following intervention categories: feasibility and logistics, decision aids, reminders, motivational interviewing, and remote expert evaluation. Reminders were the most robust area of the literature, with more RCTs and large-scale studies conducted. Many studies compared the efficacy of automated screening reminders with those performed by staff. Common outcomes that were measured in all categories except remote expert evaluation were patient acceptability and CRC screening completion within designated time frames. Articles about decision aids exhibited heterogeneity of dissemination method and types of informational materials included. Studies on remote expert evaluation were variable in scope and reported results for interobserver reliability and sensitivity. Of the studies included, nine took place or were targeted for application in rural or remote areas. Of those nine studies, five were about reminders, reflecting trends in the wider literature.
Discussion: Given the paucity of CRC screening interventions that were studied in rural areas, further investigation is needed to determine whether broadly studied telemedicine interventions are applicable, particularly since underserved populations in rural areas stand to benefit disproportionately from evidence-based telemedicine interventions.
Citation Format: Chanelle Y. Chua, Carolyn Stoll, Julia Maki, Graham Colditz, Aimee James. Opportunities for connection: A scoping review of telemedicine interventions in colorectal cancer screening in rural and nonrural settings [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A011.
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