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Likely uptake of a future a lung cancer screening programme in Hodgkin lymphoma survivors: a questionnaire study. BMC Pulm Med 2022; 22:165. [PMID: 35484621 PMCID: PMC9052526 DOI: 10.1186/s12890-022-01959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n = 165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64–21.44, p < 0.01), living in an area with a high index of multiple deprivation decile (deciles 6–10) (OR 8.22 CI 1.59–42.58, p < 0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30–2.08 p < 0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in order to minimise barriers to participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01959-3.
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Implementation of long-term non-participant reminders for flexible sigmoidoscopy screening. Prev Med Rep 2021; 21:101308. [PMID: 33505841 PMCID: PMC7815459 DOI: 10.1016/j.pmedr.2020.101308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022] Open
Abstract
Long-term self-referral reminders increased uptake by 4.1%. 13% of those who self-referred had pre-cancerous lesions detected. The biggest effects were seen in the most deprived areas.
The clinical effectiveness of screening is highly dependent on uptake. Previous randomised controlled trials suggest that non-participant reminders, which highlight the opportunity to re-book an appointment, can improve participation. The present analysis examines the impact of implementing these reminders within the English Flexible Sigmoidoscopy (FS) Screening Programme, which offers once-only FS screening to adults aged 55–59 years. We assessed the screening status of 26,339 individuals invited for once-only FS screening in England. A total of 10,952 (41.6%) had attended screening, and were subsequently ineligible. The remaining 15,387 had not attended screening, and were selected to receive a reminder, 1–2 years after their invitation. Descriptive statistics were used to assess the increase in uptake and the adenoma detection rate (ADR) of those who self-referred, six months after the delivery of the final reminder. Pearson’s Chi-Square was used to compare the ADR between those who attended when invited and those who self-referred. Of the 15,387 adults eligible to receive a reminder, 13,626 (88.6%) were sent a reminder as intended (1,761 were not sent a reminder, due to endoscopy capacity). Of these, 8.0% (n = 1,086) booked and attended an appointment, which equated to a 4.1% increase in uptake from 41.6% at baseline, to 45.7% at follow-up. The ADR was significantly higher for those who self-referred, compared with those who attended when invited (13.3% and 9.5%, respectively; X2 = 16.138, p = 0.000059). The implementation of non-participant reminders led to a moderate increase in uptake. Implementing non-participant reminders could help mitigate the negative effects of COVID-19 on uptake.
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Kaushal A, Hirst Y, Tookey S, Kerrison RS, Marshall S, Prentice A, Vulkan D, Duffy S, von Wagner C. Use of a GP-endorsed non-participant reminder letter to promote uptake of bowel scope screening: A randomised controlled trial in a hard-to-reach population. Prev Med 2020; 141:106268. [PMID: 33022321 PMCID: PMC7732700 DOI: 10.1016/j.ypmed.2020.106268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
Previous research suggests that sending non-participants a reminder letter, 1 year after their initial invitation, can improve coverage for bowel scope screening (BSS), also known as flexible sigmoidoscopy screening. We hypothesised that adding a general practitioner's (GPs) endorsement to the reminder letter could improve coverage even further. We conducted a randomised controlled trial in North West London, UK. Participants were screening-eligible men and women who had not responded to their initial BSS invitation at least 12 months prior to the trial period. Eligible adults were randomised in a 1:1 ratio to receive either a GP-endorsed reminder letter, or a standard reminder letter from June to August 2019. Logistic regression models were used to test the effect of the GP endorsement on attendance at BSS, adjusting for sex, clinical commissioning group, and local area socioeconomic deprivation. In total, 1200 participants were enrolled into the study and randomised to either the control (n = 600) or the intervention (n = 600) group. Those who received the GP-endorsed reminder letter were only slightly more likely to attend BSS than those who received the standard reminder letter (4% vs. 3%); this difference was not statistically significant (Adjusted OR = 1.30; 95% CI: 0.69, 2.43). Adding a GP-endorsement to the annual reminder letter did not have an effect on attendance at BSS. One possible explanation for this is that the endorsement used was not personalised enough. Future research should examine stronger GP-endorsements or other methods to promote uptake.
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Affiliation(s)
- Aradhna Kaushal
- Research Department of Behavioural Science and Health, University College London, London, UK.
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sara Tookey
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah Marshall
- St Mark's Bowel Cancer Screening Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Andrew Prentice
- St Mark's Bowel Cancer Screening Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Daniel Vulkan
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Riordan F, Racine E, Smith SM, Murphy A, Browne J, Kearney PM, Bradley C, James M, Murphy M, McHugh SM. Feasibility of an implementation intervention to increase attendance at diabetic retinopathy screening: protocol for a cluster randomised pilot trial. Pilot Feasibility Stud 2020; 6:64. [PMID: 32426158 PMCID: PMC7216495 DOI: 10.1186/s40814-020-00608-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetic retinopathy screening (DRS) leads to the earlier detection of retinopathy and treatment that can prevent or delay the development of diabetes-related blindness. However, uptake continues to be sub-optimal in many countries, including Ireland. Routine management of type 2 diabetes largely takes place in primary care. As such, there may be an opportunity in primary care to introduce interventions to improve DRS uptake. However, few studies test the feasibility of interventions to enhance DRS uptake in this context. Our aim is to investigate the feasibility of an implementation intervention (IDEAs (Improving Diabetes Eye screening Attendance)) delivered in general practice to improve the uptake of the national DRS programme, RetinaScreen. METHODS The IDEAs study is a cluster randomised pilot trial with an embedded process evaluation and economic evaluation. Following stratification by practice size, eight general practices (clusters) will be randomly allocated to intervention (n = 4) or wait-list control groups (n = 4). The intervention will be delivered for 6 months, after which, it will be administered to wait-list control practices. The intervention is multi-faceted and comprises provider-level components (training, audit and feedback, health care professional prompt, reimbursement) and patient-level components (GP-endorsed reminder with information leaflet delivered opportunistically face-to-face, and systematically by phone and letter). Patient inclusion criteria are type 1 or type 2 diabetes and DRS programme non-attendance. A multi-method approach will be used to determine screening uptake, evaluate the trial and study procedures and examine the acceptability and feasibility of the intervention from staff and patient perspectives. Quantitative and qualitative data will be collected on intervention uptake and delivery, research processes and outcomes. Data will be collected at the practice, health professional and patient level. A partial economic evaluation will be conducted to estimate the cost of delivering the implementation intervention in general practice. Formal continuation criteria will be used to determine whether IDEAs should progress to a definitive trial. DISCUSSION Findings will determine whether IDEAsis feasible and acceptable and will be used to refine the intervention and study procedures. A definitive trial will determine whether IDEAs is a cost-effective intervention to improve DRS uptake and reduce diabetes-related blindness. TRIAL REGISTRATION ClinicalTrials.gov NCT03901898. Registered 3rd April 2019.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Mark James
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Sheena M. McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Hausmann J, Linke JP, Albert JG, Masseli J, Tal A, Kubesch A, Filmann N, Philipper M, Farnbacher M. Time-saving polyp detection in colon capsule endoscopy: evaluation of a novel software algorithm. Int J Colorectal Dis 2019; 34:1857-1863. [PMID: 31520200 DOI: 10.1007/s00384-019-03393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a reliable method to detect colonic polyps in the well-prepared colon. As CCE evaluation can be time consuming, a new software algorithm might aid in reducing evaluation time. OBJECTIVES The aim of the study was to evaluate whether it is feasible to reliably detect colon polyps in CCE videos with a new software algorithm the "collage mode" (Rapid 8 Software, Covidien/Medtronic®). METHODS Twenty-nine CCE videos were randomly presented to three experienced and to three inexperienced investigators. Videos were evaluated by applying the collage mode. Investigation time was documented and the results (≥one polyp vs. no polyp) were compared with the findings of two highly experienced central readers who read the CCE videos in the standard mode beforehand. RESULTS It took a median time of 9.8, 3.5, and 7.5 vs. 4.3, 4.6 and 12.5 min for experienced vs. inexperienced investigators to review the CCE videos. For detecting ≥one polyp vs. no polyp, sensitivity of 93.3%, 73.3%, and 93.3% was observed for the experienced and sensitivity of 46.7%, 33.3%, and 93.3% for the inexperienced CCE readers. CONCLUSION Collage mode might allow for a quick review of CCE videos with a high polyp detection rate for experienced CCE readers. Future prospective studies should include CCE collage mode for rapid polyp detection to further prove the feasibility of practical colon polyp detection by CCE and possibly support the role of CCE as a screening tool in CRC prevention.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.
| | - Jan-Peter Linke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.,Department of Internal Medicine, Heilig-Geist-Hospital, Bingen, Germany
| | - Jörg G Albert
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.,Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Johannes Masseli
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Andrea Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Alica Kubesch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
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von Wagner C, Hirst Y, Waller J, Ghanouni A, McGregor LM, Kerrison RS, Verstraete W, Vlaev I, Sieverding M, Stoffel ST. The impact of descriptive norms on motivation to participate in cancer screening - Evidence from online experiments. PATIENT EDUCATION AND COUNSELING 2019; 102:1621-1628. [PMID: 30975450 PMCID: PMC6686210 DOI: 10.1016/j.pec.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals. METHODS 2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant's estimate, as well as the stated proportion of men and women doing the screening test. RESULTS Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit. CONCLUSION Screening intention can be effectively manipulated through a high uptake message. PRACTICE IMPLICATIONS Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.
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Affiliation(s)
- Christian von Wagner
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK.
| | - Yasemin Hirst
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Jo Waller
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Alex Ghanouni
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Lesley M McGregor
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Robert S Kerrison
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Wouter Verstraete
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Ivo Vlaev
- University of Warwick, Warwick Business School, Scarman Road, CV4 7AL, Coventry, UK
| | - Monika Sieverding
- University of Heidelberg, Institute of Psychology, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Sandro T Stoffel
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
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Zabih V, Kahane A, O'Neill NE, Ivers N, Nathan PC. Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:713-729. [PMID: 31338733 DOI: 10.1007/s11764-019-00790-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence. METHODS We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878. RESULTS Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests. CONCLUSION The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population. IMPLICATIONS FOR CANCER SURVIVORS Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
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Affiliation(s)
- Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Kerrison RS, McGregor LM, Counsell N, Marshall S, Prentice A, Isitt J, Rees CJ, von Wagner C. Use of Two Self-referral Reminders and a Theory-Based Leaflet to Increase the Uptake of Flexible Sigmoidoscopy in the English Bowel Scope Screening Program: Results From a Randomized Controlled Trial in London. Ann Behav Med 2018; 52:941-951. [PMID: 30346495 PMCID: PMC6196365 DOI: 10.1093/abm/kax068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background We previously initiated a randomized controlled trial to test the effectiveness of two self-referral reminders and a theory-based leaflet (sent 12 and 24 months after the initial invitation) to increase participation within the English Bowel Scope Screening program. Purpose This study reports the results following the second reminder. Methods Men and women included in the initial sample (n = 1,383) were re-assessed for eligibility 24 months after their invitation (12 months after the first reminder) and excluded if they had attended screening, moved away, or died. Eligible adults received the same treatment they were allocated 12 months previous, that is, no reminder ("control"), or a self-referral reminder with either the standard information booklet ("Reminder and Standard Information Booklet") or theory-based leaflet designed using the Behavior Change Wheel ("Reminder and Theory-Based Leaflet"). The primary outcome was the proportion screened within each group 12 weeks after the second reminder. Results In total, 1,218 (88.1%) individuals were eligible. Additional uptake following the second reminder was 0.4% (2/460), 4.8% (19/399), and 7.9% (29/366) in the control, Reminder and Standard Information Booklet, and Reminder and Theory-Based Leaflet groups, respectively. When combined with the first reminder, the overall uptake for each group was 0.7% (3/461), 14.5% (67/461), and 21.5% (99/461). Overall uptake was significantly higher in the Reminder and Standard Information Booklet and Reminder and Theory-Based Leaflet groups than in the control (odds ratio [OR] = 26.1, 95% confidence interval [CI] = 8.1-84.0, p < .001 and OR = 46.9, 95% CI = 14.7-149.9, p < .001, respectively), and significantly higher in the Reminder and Theory-Based Leaflet group than in the Reminder and Standard Information Booklet group (OR = 1.8, 95% CI = 1.3-2.6, p < .001). Conclusion A second reminder increased uptake among former nonparticipants. The added value of the theory-based leaflet highlights a potential benefit to reviewing the current information booklet. Trials Registry Number ISRCTN44293755.
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Affiliation(s)
- Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - Andrew Prentice
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - John Isitt
- Partners in Creation, Top Studio, London, UK
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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von Wagner C, Bonello B, Stoffel S, Skrobanski H, Freeman M, Kerrison RS, McGregor LM. Barriers to bowel scope (flexible sigmoidoscopy) screening: a comparison of non-responders, active decliners and non-attenders. BMC Public Health 2018; 18:1161. [PMID: 30290783 PMCID: PMC6173878 DOI: 10.1186/s12889-018-6071-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Participation in bowel scope screening (BSS) is low (43%), limiting its potential to reduce colorectal cancer (CRC) incidence and mortality. This study aimed to quantify the prevalence of barriers to BSS and examine the extent to which these barriers differed according to non-participant profiles: non-responders to the BSS invitation, active decliners of the invitation, and non-attenders of confirmed appointments. METHODS Individuals invited for BSS between March 2013 and December 2015, across 28 General Practices in England, were sent a questionnaire. Questions measured initial interest in BSS, engagement with the information booklet, BSS participation, and, where applicable, reasons for BSS non-attendance. Chi-square tests of independence were performed to examine the relationship between barriers, non-participant groups and socio-demographic variables. RESULTS 1478 (45.8%) questionnaires were returned for analysis: 1230 (83.2%) attended screening, 114 (7.7%) were non-responders to the BSS invitation, 100 (6.8%) were active decliners, and 34 (2.3%) were non-attenders. Non-responders were less likely to have read the whole information booklet than active decliners (x2 (2, N = 157) = 7.00, p = 0.008) and non-attenders (x2 (2, N = 101) = 8.07, p = 0.005). Non-responders also had lower initial interest in having BSS than either active decliners (x2 (2, N = 213) = 6.07, p = 0.014) or non-attenders (x2 (2, N = 146) = 32.93, p < 0.001). Overall, anticipated pain (33%) and embarrassment (30%) were the most commonly cited barriers to BSS participation. For non-attenders, however, practical, appointment-related reasons were most common (27%). CONCLUSIONS Interventions to improve BSS uptake should be more nuanced and use targeted strategies to address the specific needs of each group.
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Affiliation(s)
- Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Bernardette Bonello
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G2 3QB UK
| | - Sandro Stoffel
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Hanna Skrobanski
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
- School of Health Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Madeleine Freeman
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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10
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von Wagner C, Hirst Y, Tookey S, Kerrison RS, Marshall S, Prentice A, Vulkan D, Macleod U, Duffy S. Use of a GP-endorsed 12 months' reminder letter to promote uptake of bowel scope screening: protocol for a randomised controlled trial in a hard-to-reach population. BMJ Open 2018; 8:e022263. [PMID: 29730633 PMCID: PMC5942414 DOI: 10.1136/bmjopen-2018-022263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Flexible sigmoidoscopy (FS) screening is associated with reduced colorectal cancer incidence and mortality when offered as a one-off test to men and women aged 55-64. The test, also referred to as the 'bowel scope screening' (BSS) test, was added to England's national Bowel Cancer Screening Programme in March 2013, where it is offered to men and women aged 55. Since its implementation, uptake of the BSS test has been low, with only 43% of the eligible population attending an appointment. Sending non-participants a reminder at age 56 has been shown to improve uptake by up to nine percentage points at a single centre in London; we hypothesise that adding a general practitioners (GPs) endorsement to the reminder could improve uptake even further. METHODS AND ANALYSIS This paper describes the protocol for a randomised controlled trial which will examine the effectiveness of adding a GPs endorsement to a reminder for BSS non-participants aged 56. All screening-eligible adults who have not responded to a BSS appointment at London North West Healthcare NHS Trust within 12 months of their initial invitation will be randomised to receive either a GP-endorsed reminder letter or reminder letter without GP endorsement. The primary outcome will be the proportion of individuals screened within each group 8 weeks after the reminder. Statistical comparisons will be made using univariate and multivariate logistic regression, with 'uptake' as the outcome variable, GP reminder group as the exposure and sociodemographic variables as covariates. ETHICS AND DISSEMINATION The study was approved by the Yorkshire & Humber-Bradford Leeds Research Ethics Committee (16/YH/0298) and the Confidentiality Advisory Group (17/CAG/0162). The results will be disseminated in a peer-reviewed journal in accordance with the Consort statement and will be made available to the public. TRIAL REGISTRATION NUMBER ISRCTN82867861.
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Affiliation(s)
- Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sara Tookey
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert S. Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, London North West Healthcare NHS Trust, Harrow, UK
| | - Andrew Prentice
- St Mark’s Bowel Cancer Screening Centre, London North West Healthcare NHS Trust, Harrow, UK
| | - Daniel Vulkan
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Una Macleod
- Centre for Health and Population Sciences, Hull York Medical School, University of York, Heslington, UK
| | - Stephen Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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