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PORTLAND, OR – A recent clinical trial has demonstrated promising results in increasing colorectal cancer (CRC) screening rates among Medicaid enrollees in rural areas. The study, a collaborative effort between Oregon Health & Science University’s (OHSU) Oregon Rural Practice-based Research Network (ORPRN) and the Kaiser Permanente Center for Health Research, found that a combination of mailed stool-based tests and patient navigation significantly improved screening participation.
Published in JAMA Network Open, the research addressed the longstanding challenge of low CRC screening rates in rural communities, where approximately 60 million adults reside in the United States. The trial involved 28 rural Oregon clinics and 5,614 Medicaid enrollees aged 50 to 75, in partnership with three Medicaid health plans.
The intervention involved mailing fecal immunochemical test (FIT) kits to participants and providing patient navigation for those with abnormal results to facilitate follow-up colonoscopies. Clinics were divided into two groups: one receiving the intervention and the other following usual care practices.
“Effective treatments can be slow to reach rural populations,” said Melinda Davis, Ph.D., M.C.R., director of OHSU’s ORPRN and senior author of the study. “This research and other studies by our team help bridge this gap to ensure all patients receive high-quality care, whether they live in rural or urban areas.”
Gloria Coronado, Ph.D., co-lead of the study and an epidemiologist at the University of Arizona Cancer Center, emphasized the importance of partnering with Medicaid health plans. “Individuals who live in rural regions often face additional barriers to receiving cancer screening exams,” Coronado said. “We partnered with Medicaid health plans because they could offer centralized resources to promote colorectal cancer screening.”
The results showed a significant increase in screening participation in the intervention group. Within six months, 11.8% of participants completed CRC screening, compared to 4.5% in the usual care group. Furthermore, 43.3% of those with abnormal FIT results in the intervention group completed a follow-up colonoscopy, compared to only 15.4% in the usual care group.
“CRC screening is so effective, but also really complicated for clinical practices to implement,” said Jennifer Coury, M.S., senior research project manager for ORPRN and a co-author of the study.
The study also highlighted the successful implementation of the program, with nearly all eligible participants receiving FIT kits and reminders. However, only about 58% of those needing follow-up colonoscopy were successfully navigated through the process, indicating areas for improvement.
“Implementing mailed FIT outreach and patient navigation improves screening, which saves lives from the second leading cause of cancer death in the U.S.,” Davis said. “Our research demonstrates the value of national investments in biomedical research and the value of studies which address patient and system-level factors that present barriers to health care access.”
The researchers suggest future efforts focus on reaching individuals without primary care providers and clustering support outreach for multiple cancer screenings.
More information: Gloria D. Coronado et al, Mailed Outreach and Patient Navigation for Colorectal Cancer Screening Among Rural Medicaid Enrollees, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.0928
Disclaimer: This news article is based on information provided from the referenced study. While the study shows promising results, it is important to consult with a healthcare professional for personalized medical advice. Results from clinical trials may not be generalizable to all populations, and further research may be necessary to confirm these findings.
