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Screening reduces colorectal cancer mortality; however, this remains the second leading cause of cancer deaths in the United States and adherence to colorectal cancer screening falls far short of the National Colorectal Cancer Roundtable goal of 80%. Numerous studies have examined the effectiveness of interventions to increase colorectal cancer screening uptake. Outreach is the active dissemination of screening outside of the primary care setting, such as mailing fecal blood tests to individuals' homes. Navigation uses trained personnel to assist individuals through the screening process. Patient education may take the form of brochures, videos, or websites. Provider education can include feedback about screening rates of patient panels. Reminders to healthcare providers can be provided by dashboards of patients due for screening. Financial incentives provide monetary compensation to individuals when they complete screening tests, either as fixed payments or via a lottery. Individual preference for specific screening strategies has also been examined in several trials, with a choice of screening strategies yielding higher adherence than recommendation of a single strategy. The most effective interventions to increase screening include outreach with mailed or in-person distributed fecal blood tests; and patient navigation. Moreover, multicomponent interventions may increase uptake more than single component interventions, especially interventions that target several levels of the cancer screening continuum including the patient; providers and healthcare delivery teams; family and social supports; and the healthcare environment. The financial, political and cultural barriers to screening must be overcome and a national colorectal cancer screening program should be adopted to improve the health of our population.

Purpose: To explore financial incentives as an intervention to improve colorectal cancer screening (CRCS) adherence among traditionally disadvantaged patients who have never been screened or are overdue for screening. Approach: We used qualitative methods to describe patients' attitudes toward the offer of incentives, plans for future screening, and additional barriers and facilitators to CRCS. Setting: Kaiser Permanente Washington (KPWA). Participants: KPWA patients who were due or overdue for CRCS. Method: We conducted semi-structured qualitative interviews with 37 patients who were randomized to 1 of 2 incentives (guaranteed $10 or a lottery for $50) to complete CRCS. Interview transcripts were analyzed using a qualitative content approach. Results: Patients generally had positive attitudes toward both types of incentives, however, half did not recall the incentive offer at the time of the interview. Among those who recalled the offer, 95% were screened compared to only 25% among those who did not remember the offer. Most screeners stated that staying healthy was their primary motivator for screening, but many suggested that the incentive helped them prioritize and complete screening. Conclusions: Incentives to complete CRCS may help motivate patients who would like to screen but have previously procrastinated. Future studies should ensure that the incentive offer is noticeable and shorten the deadline for completion of FIT screening.

Purpose We explored intervention fidelity, participant satisfaction, and the goals and reminder strategies participants chose to reduce sitting. Approach Mixed methods approach leveraging data collected during study coaching and fidelity monitoring. Setting A successful 6-month randomized controlled trial of a sedentary behavior (SB) intervention for adults ≥60 years in Washington, USA. Participants N = 283 (140 intervention, 143 attention control); mean age 69, 66% women, 69% Non-Hispanic White. Intervention Theory-based SB reduction intervention structured around phone-based health coaching and goal setting. Attention control received equal coaching on non-SB health topics. Method Coaches tracked all participant goals, and 8% of visits were randomly observed and fidelity coded using a structured template. Participants completed a satisfaction questionnaire at study end. Goals data were qualitatively grouped by reminder strategy and topic. Fidelity and satisfaction data were summarized and compared by study arm using two-sided paired t-tests. Results Both participants' satisfaction (>90% satisfied, between-group P = .195) and coach fidelity to intervention content and techniques were high (96% sessions set SMART goals, P = .343) across both arms. Intervention participants primarily set goals leveraging outward (e.g., fitness band prompts) and habit (e.g., adding standing to a daily meal) reminder strategies highly tailored to individual preferences and lifestyle. Conclusion Participants' SB-related goals varied widely, suggesting tailored intervention approaches are important to change sitting behavior, particularly for older adults with chronic conditions.

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.