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Myers L, Ireland MJ, Viljoen B, Goodwin B. Evaluating changes to home bowel cancer screening kits: an end-user perspective study. Cancer Causes Control 2023; 34:583-594. [PMID: 37081155 DOI: 10.1007/s10552-023-01695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Many people do not participate in mail-out bowel cancer screening programs due to difficulties using the screening kit. The current study investigated the ways the screening kit could be modified to improve usability. METHODS 1,109 people evaluated 15 different screening kit modifications. Participants reported on how these kit modifications would affect their screening barriers, their future screening intentions, and how much they would recommend that the modification is made to the current screening kit used the program. All responses were given via an online survey conducted between April and December of 2021. RESULTS Seventeen percent of previous NBCSP non-participators indicated that a one-sample test would increase their intention to participate. Recommendation ratings demonstrated higher levels of support for modifications that included providing a barcode naming label (M = 9.06, 95% CI [8.81, 9.31]), having a larger diameter opening of the collection tube (M = 8.42, 95% CI [8.10, 8.74]), and highlighting the expiry date on the kit packaging (M = 8.59, 95% CI [8.29, 8.89]). There were lower levels of support for modifications that reduced the size of the packaging the kit is sent in (M = 6.47, 95% CI [6.09, 6.85]), removed branding from kit packaging (M = 5.98, 95% CI [5.57, 6.39]), and removed the information booklet that comes with the screening kit (M = 5.25, 95% CI [4.78, 5.72]). CONCLUSION These findings highlight multiple ways in which bowel cancer screening kits can be changed to increase usability for invitees of national bowel cancer screening programs. Findings have implications for all screening programs that use immunochemical-based bowel cancer screening kits.
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Affiliation(s)
- L Myers
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Brisbane, QLD, 4006, Australia.
- School of Psychology and Well-Being, University of Southern Queensland, Springfield, Australia.
| | - M J Ireland
- School of Psychology and Well-Being, University of Southern Queensland, Springfield, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - B Viljoen
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Brisbane, QLD, 4006, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - B Goodwin
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Brisbane, QLD, 4006, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
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Myers L, Goodwin BC, Ireland M, March S, Aitken J. Mail-out bowel cancer screening: Identifying the behavioural stumbling blocks. Psychooncology 2021; 31:816-823. [PMID: 34967054 DOI: 10.1002/pon.5866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the actions taken by recipients of mail-out faecal occult blood test (FOBT) kits and to identify the points at which progress towards kit completion typically stops. Differences according to gender, age, and screening intention were also examined. METHODS 1599 people completed an online survey identifying the actions they took upon receiving an FOBT kit. Latent class analysis was conducted to identify latent subgroups of participants that reported similar actions. Differences between gender, age, and intention status were assessed using non-invariance testing. RESULTS Four latent subgroups of FOBT invitees were identified: those who complete and return their FOBT kit ('completers'); those who bring the kit into their house but go no further ('ignorers'); those who open the package and read the bowel cancer information materials but go no further ('readers'); and those who read the instructions but do not place the kit near the toilet and do not complete their FOBT kit ('leavers'). Non-completers who intended to use the kit were most likely to be in the 'leavers' class, while those who had no intention were most likely to be in the 'readers' class. CONCLUSIONS Distinct subgroups of non-responders exist among bowel cancer screening invitees, suggesting different behaviour change interventions are needed to facilitate participation. Some invitees, especially those with high participatory intention, are likely to benefit from prompts to take the kit into the toilet, while others, with little participatory intention, often read the invitation materials presenting an opportunity to intervene with health messages.
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Affiliation(s)
- Larry Myers
- Cancer Council Queensland, Brisbane, Australia.,Centre for Health Research, University of Southern Queensland, Springfield, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Australia
| | - Belinda C Goodwin
- Cancer Council Queensland, Brisbane, Australia.,Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - Michael Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Australia
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Springfield, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Australia
| | - Joanne Aitken
- Cancer Council Queensland, Brisbane, Australia.,Centre for Health Research, University of Southern Queensland, Springfield, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,School of Public Health, The University of Queensland, Herston, Australia
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3
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Thompson J, Ng J, Armstrong B, Feletto E, Ha T. Differences in colorectal cancer (CRC) patients who did and did not undergo screening: Results from the 45 and Up Study cohort. Cancer Epidemiol 2021; 72:101936. [PMID: 33839458 DOI: 10.1016/j.canep.2021.101936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Australian National Bowel Cancer Screening Program is a free population-based screening program aiming to identify precancerous lesions and early colorectal cancer using faecal occult blood tests in average-risk Australians. The participation rate in people invited to screening was 42 % in 2017-2018, well below the 56.6 % target level. Increasing screening in high-risk groups; such as those with a subsequent diagnosis of colorectal cancer, will improve the efficiency of the program. METHODS Patients were participants in the Australian 45 and Up (cohort) study; aged 55 or 65 years between May 2006 and June 2008. Patients reported a history of colorectal cancer in their enrolment questionnaire and whether or not they had screened before diagnosis. Demographic, lifestyle, dietary and health related characteristics were compared between those who did and did not participate in screening. RESULTS 339 participants who self-reported having colorectal cancer were included. Participants who were female, overweight (≥ 25 kg/m2), consumed less than the recommended five servings of vegetables per day, consumed ≤ 14 standard drinks per week (compared to non-drinkers) or did not meet physical activity guidelines were significantly less likely to have participated in screening. CONCLUSION Considerable investment has been placed in the National Bowel Cancer Screening Program and the focus now is on improving participation. Our study has taken a unique approach to identifying high-risk groups by exploring factors related to screening participation in colorectal cancer patients. These findings can further leverage the program by targeting high-risk populations to reduce the colorectal cancer burden in Australia.
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Affiliation(s)
| | - James Ng
- University of Wollongong, Australia.
| | - Bruce Armstrong
- University of Sydney, Australia; University of Western Australia, Australia.
| | | | - Tam Ha
- University of Wollongong, Australia; Sax Institute, Australia.
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Fahy L, Fitzpatrick P, Meade C, Farrell HC, O'Donoghue D, Mooney T. Impact of the introduction of a new policy of direct faecal immunochemical home screening test provision in a national bowel screening programme, both during and outside of advertising campaigns. Cancer Epidemiol 2020; 69:101844. [PMID: 33099212 DOI: 10.1016/j.canep.2020.101844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND BowelScreen, The National Bowel Screening Programme in Ireland, offers free colorectal screening to persons aged 60-69 through a home Faecal Immunochemical Test (FIT) kit. 40.2% uptake in the first screening round was below the programme standard (≥50.0%). To improve uptake, an intervention saw FIT kits sent directly to previously screened clients rather than by the usual invitation process comprising a letter of invitation followed by a FIT kit if requested. The intervention proved successful and was fully implemented into the programme for subsequent clients. Despite the improved uptake it was noted over time that the unsatisfactory FIT rate was approaching the programme standard (≤3%). The aim of this study is to compare uptake by two invite methods occurring contemporaneously alongside advertising and to compare unsatisfactory rates before and after full FIT-Direct implementation. METHODS Percentage uptake and 95% confidence intervals (CI) were calculated for each invite method before and after advertising and compared using two-proportion z-tests. Rate ratios and 95% CI compared the unsatisfactory FIT rate before and after full-FIT Direct implementation. RESULTS Uptake was significantly higher amongst FIT-Direct compared with Usual-Invite clients during (91.0% vs 84.9%, p < 0.0001) and outside advertising (93.8% vs 85.3%, p < 0.0001). The unsatisfactory FIT rate was 2.3 times higher (95% CI: 1.84-2.92, p < 0.0001) after full FIT-Direct implementation compared with before. CONCLUSIONS The FIT-Direct intervention had an overall positive effect on uptake. After adjusting for advertising, uptake of FIT was higher outside advertising periods. Monitoring of the unsatisfactory rate is ongoing; a communication enhancement strategy may be required should this persist.
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Affiliation(s)
- Lorraine Fahy
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland.
| | - Patricia Fitzpatrick
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland; UCD School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Caroline Meade
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland.
| | - Hilary Coffey Farrell
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland.
| | - Diarmuid O'Donoghue
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland.
| | - Therese Mooney
- National Screening Service, King's Inns House, 200 Parnell Street, Dublin, D01 A3Y8, Ireland.
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5
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Myers L, Goodwin B, Ralph N, Castro O, March S. Implementation Strategies for Interventions Aiming to Increase Participation in Mail-Out Bowel Cancer Screening Programs: A Realist Review. Front Oncol 2020; 10:543732. [PMID: 33117681 PMCID: PMC7550731 DOI: 10.3389/fonc.2020.543732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Bowel cancer is the third most commonly diagnosed cancer and the third most common cause of cancer-related death, with 1,849,518 new cases of bowel diagnosed and 880,792 deaths reported globally in 2018 alone. Survival can be improved through early detection via national mail-out bowel cancer screening programs; however, participation remains low in many countries. Behavior change is therefore required to increase participation. This realist review aims to (a) identify the behavior change techniques (BCTs) used in each intervention, (b) understand the mechanisms of action (MoAs) responsible for the BCT effectiveness, and (c) apply a behavior change model to inform how MoAs can be combined to increase screening participation. Methods: We systematically reviewed the literature for interventions aiming to increase participation in mail-out bowel cancer screening. We used a four-stage realist synthesis approach whereby (1) interventions were extracted from each study; (2) BCTs applied in each intervention were identified and coded using the BCT Taxonomy-v1; (3) the Theory and Techniques Tool was used to link BCTs to their MoA; and (4) BCTs and MoAs were categorized according to their effectiveness and what Health Action Process Approach (HAPA) stage of change they would affect. Results: We identified 68 intervention trials using 26 unique BCTs and 13 MoAs to increase participation. Sixteen BCTs and 10 MoAs were identified within the interventions that successfully increased participation rates. Interventions targeting both stages of the HAPA model had a higher success rate (80%) than those targeting one stage of change (51%). When targeting only one stage, interventions targeting the volitional stage had a higher success rate (71%) than interventions targeting only the motivational stage of change (26%). Conclusion: Importantly, this review identified a suite of BCTs and MoAs effective for increasing participation in mail-out bowel cancer screening programs. With increased participation in bowel cancer screening leading to improved survival, our findings are key to informing the improvement of policy and interventions that aim to increase screening using specific strategies at key stages of health decision-making.
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Affiliation(s)
- Larry Myers
- Centre for Health, Informatics, and Economic Research, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Nicholas Ralph
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Oscar Castro
- Physically Active Lifestyles Research Group, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Centre for Health, Informatics, and Economic Research, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
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Feletto E, Lew JB, Worthington J, He E, Caruana M, Butler K, Hui H, Taylor N, Banks E, Barclay K, Broun K, Butt A, Carter R, Cuff J, Dessaix A, Ee H, Emery J, Frayling IM, Grogan P, Holden C, Horn C, Jenkins MA, Kench JG, Laaksonen MA, Leggett B, Mitchell G, Morris S, Parkinson B, St John DJ, Taoube L, Tucker K, Wakefield MA, Ward RL, Win AK, Worthley DL, Armstrong BK, Macrae FA, Canfell K. Pathways to a cancer-free future: a protocol for modelled evaluations to minimise the future burden of colorectal cancer in Australia. BMJ Open 2020; 10:e036475. [PMID: 32565470 PMCID: PMC7307542 DOI: 10.1136/bmjopen-2019-036475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With almost 50% of cases preventable and the Australian National Bowel Cancer Screening Program in place, colorectal cancer (CRC) is a prime candidate for investment to reduce the cancer burden. The challenge is determining effective ways to reduce morbidity and mortality and their implementation through policy and practice. Pathways-Bowel is a multistage programme that aims to identify best-value investment in CRC control by integrating expert and end-user engagement; relevant evidence; modelled interventions to guide future investment; and policy-driven implementation of interventions using evidence-based methods. METHODS AND ANALYSIS: Pathways-Bowel is an iterative work programme incorporating a calibrated and validated CRC natural history model for Australia (Policy1-Bowel) and assessing the health and cost outcomes and resource use of targeted interventions. Experts help identify and prioritise modelled evaluations of changing trends and interventions and critically assess results to advise on their real-world applicability. Where appropriate the results are used to support public policy change and make the case for optimal investment in specific CRC control interventions. Fourteen high-priority evaluations have been modelled or planned, including evaluations of CRC outcomes from the changing prevalence of modifiable exposures, including smoking and body fatness; potential benefits of daily aspirin intake as chemoprevention; increasing CRC incidence in people aged <50 years; increasing screening participation in the general and Aboriginal and Torres Strait Islander populations; alternative screening technologies and modalities; and changes to follow-up surveillance protocols. Pathways-Bowel is a unique, comprehensive approach to evaluating CRC control; no prior body of work has assessed the relative benefits of a variety of interventions across CRC development and progression to produce a list of best-value investments. ETHICS AND DISSEMINATION Ethics approval was not required as human participants were not involved. Findings are reported in a series of papers in peer-reviewed journals and presented at fora to engage the community and policymakers.
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Affiliation(s)
- Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joachim Worthington
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily He
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Butler
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Harriet Hui
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Barclay
- Northern Clinical School, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Broun
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alison Butt
- Research Strategy Office, University of New South Wales, Sydney, New South Wales, Australia
| | - Rob Carter
- Deakin Institute for Health Research, Deakin University, Melbourne, Victoria, Australia
| | - Jeff Cuff
- Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales, Australia
- Research Advocate, Sydney, New South Wales, Australia
| | - Anita Dessaix
- Cancer Prevention and Advocacy, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Hooi Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Ian M Frayling
- Inherited Tumour Syndromes Research Group, Division of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Paul Grogan
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carol Holden
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Christopher Horn
- Cancer Institute New South Wales, Eveleigh, New South Wales, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
| | - James G Kench
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Leggett
- Conjoint Gastroenterology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
- Gastroenterology & Hepatology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Morris
- Research Advocate, Sydney, New South Wales, Australia
- Lynch Syndrome Australia, Brisbane, Queensland, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - D James St John
- Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Taoube
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia
- Precision Prevention and Early Detection, University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel L Worthley
- No Australians Dying of Bowel Cancer Initiative, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Bruce K Armstrong
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Finlay A Macrae
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Genetic Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Tsipa A, O'Connor DB, Branley-Bell D, Day F, Hall LH, Sykes-Muskett B, Wilding S, Taylor N, Conner M. Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake. Health Psychol Rev 2020; 15:371-394. [PMID: 32401175 DOI: 10.1080/17437199.2020.1760726] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) represents a global public health concern. CRC screening is associated with significant reductions in CRC incidence and mortality, however, uptake is suboptimal. This systematic review and meta-analysis of randomised controlled trials explored the effectiveness of interventions designed to increase screening uptake, plus the impact of various moderators. Data from 102 studies including 1.94 million participants were analysed. Results showed significant benefit of all interventions combined (OR, 1.49, 95% CI: 1.43, 1.56, p < 0.001). The effects were similar in studies using objective versus self-reported uptake measures and lower in studies judged to be at high risk of bias. Moderator analyses indicated significant effects for aspects of behaviour (effects lower for studies on non-endoscopic procedures), and intervention (effects higher for studies conducted in community settings, in healthcare systems that are not free, and that use reminders, health-professional providers, paper materials supplemented with in-person or phone contact, but avoid remote contact). Interventions that included behaviour change techniques targeting social support (unspecified or practical), instructions or demonstration of the behaviour, and that added objects to the environment produced stronger effects. The way in which findings can inform interventions to improve CRC screening uptake is discussed.
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Affiliation(s)
| | | | - Dawn Branley-Bell
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Fiona Day
- NHS Leeds West Clinical Commissioning Group, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Natalie Taylor
- Cancer Council New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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8
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Digby J, Cleary S, Gray L, Datt P, Goudie DR, Steele RJC, Strachan JA, Humphries A, Fraser CG, Mowat C. Faecal haemoglobin can define risk of colorectal neoplasia at surveillance colonoscopy in patients at increased risk of colorectal cancer. United European Gastroenterol J 2020; 8:559-566. [PMID: 32213041 PMCID: PMC7268942 DOI: 10.1177/2050640620913674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Quantitative faecal immunochemical tests measure faecal haemoglobin concentration (f-Hb), which increases in the presence of colorectal neoplasia. Objective We examined the diagnostic accuracy of faecal immunochemical test (FIT)in patients at increased risk of colorectal cancer (CRC) attending for surveillance colonoscopy as per national guidelines. Methods A total of 1103 consecutive patients were prospectively invited to complete a FIT before their scheduled colonoscopy in two university hospitals in 2014– 2016. F-Hb was analysed on an OC-Sensor io automated analyser (Eiken Chemical Co., Ltd, Tokyo, Japan) with a limit of detection of 2 µg Hb/g faeces. The diagnostic accuracy of f-Hb for CRC and higher-risk adenoma was examined. Results A total of 643 patients returned a faecal test. After excluding 4 patients with known inflammatory bowel disease, 639 (57.9%) remained in the study: age range: 25–90 years (median: 64 years, interquartile range (IQR): 55–71): 54.6% male. Of 593 patients who also completed colonoscopy, 41 (6.9%) had advanced neoplasia (4 CRC, 37 higher-risk adenoma). Of the 238 patients (40.1%) who had detectable f-Hb, 31 (13.0%) had advanced neoplasia (2 CRC, 29 higher-risk adenoma) compared with 10 (2.8%) in those with undetectable f-Hb (2 CRC, 8 higher-risk adenoma). Detectable f-Hb gave negative predictive values of 99.4% for CRC and 97.2% for CRC plus higher-risk adenoma. Conclusion In patients at increased risk of CRC under colonoscopy surveillance, a test measuring faecal haemoglobin can provide an objective estimate of the risk of advanced neoplasia, and could enable tailored scheduling of colonoscopy.
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Affiliation(s)
- Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Shirley Cleary
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Lynne Gray
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Pooja Datt
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - David R Goudie
- Department of Clinical Genetics, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Adam Humphries
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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9
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Worthington J, Feletto E, Lew J, Broun K, Durkin S, Wakefield M, Grogan P, Harper T, Canfell K. Evaluating health benefits and cost-effectiveness of a mass-media campaign for improving participation in the National Bowel Cancer Screening Program in Australia. Public Health 2020; 179:90-99. [DOI: 10.1016/j.puhe.2019.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022]
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10
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Goodwin BC, Ireland MJ, March S, Myers L, Crawford-Williams F, Chambers SK, Aitken JF, Dunn J. Strategies for increasing participation in mail-out colorectal cancer screening programs: a systematic review and meta-analysis. Syst Rev 2019; 8:257. [PMID: 31685010 PMCID: PMC6827213 DOI: 10.1186/s13643-019-1170-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite the increased survival rates associated with early detection of CRC, in many countries, 50% or more of eligible individuals do not participate in such programs. The current study systematically reviews interventions applied to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs. METHODS Five electronic databases (PubMed, PsycINFO, Scopus, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published before the 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return rate of FOBT kits that had been mailed to individuals' homes. PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane's Risk of Bias tool. Pooled effect sizes were calculated for each intervention type and the risk of bias was tested as a moderator for sensitivity analysis. RESULTS The review identified 53 interventions from 30 published studies from which nine distinct intervention strategy types emerged. Sensitivity analysis showed that the risk of bias marginally moderated the overall effect size. Pooled risk ratios and confidence intervals for each intervention type revealed that telephone contact RR = 1.23, 95% CI (1.08-1.40), GP endorsement RR = 1.19, 95% CI (1.10-1.29), simplified test procedures RR = 1.17, 95% CI (1.09-1.25), and advance notifications RR = 1.09, 95% CI (1.07-1.11) were effective intervention strategies with small to moderate effect sizes. Studies with a high risk of bias were removed and pooled effects remained relatively unchanged. CONCLUSIONS Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. SYSTEMATIC REVIEW REGISTRATION This review is registered with PROSPERO; registration number CRD42017064652.
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Affiliation(s)
- Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, 4300, Australia.
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, 4300, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, 4300, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Larry Myers
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, 4300, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Suzanne K Chambers
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Menzies Health Institute, Griffith University, Southport, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, 4300, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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11
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Myers L, Goodwin B, March S, Dunn J. Ways to use interventions to increase participation in mail-out bowel cancer screening: a systematic review and meta-analysis. Transl Behav Med 2019; 10:384-393. [DOI: 10.1093/tbm/ibz081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The impact of colorectal cancer can be reduced through nationwide fecal occult blood test (FOBT) screening. Unfortunately, participation in screening programs are low with interventions only increasing participation modestly.
This meta-analysis explores if intervention effectiveness can be increased by targeting specific subpopulations with specific interventions or by combining interventions. Six databases were searched for studies aiming to increase participation in mail-out FOBT screening. To investigate if interventions are more effective for certain subpopulations, the difference in (log) Risk Ratios (RRs) between alternate subpopulations (male vs. female; low vs. high Socioeconomic Status (SES); <65 vs. ≥65 years) was assessed. To investigate if interventions should be combined, uptake rates for single interventions were compared to uptake rates for combined interventions. Cochrane Collaboration tools were used to assess the risk of bias.
Searches found 3,436 articles, with 32 meeting the inclusion criteria. These contained 30 trials that reported uptake rates within subpopulations and 17 trials that combined interventions. Most differences in intervention effects between subpopulations were nonsignificant. Combining interventions led to greater participation, RR = 1.06, confidence interval [1.03; 1.10]. As interventions rarely affect subpopulations differently, targeting them at specific subpopulations may be an ineffective strategy. While individual interventions show modest effects, these results indicate that future programs might overcome this by combining interventions together. Care is needed when selecting interventions to combine as adding some interventions (e.g., additional print materials) can reduce the effectiveness of a combined strategy. Future research should examine methods for effectively combining interventions in nationwide programs to maximize participation.
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Affiliation(s)
- Larry Myers
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
- School of Social Science, University of Queensland, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Brisbane, QLD, Australia
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12
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White A, Ironmonger L, Steele RJC, Ormiston-Smith N, Crawford C, Seims A. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer 2018; 18:906. [PMID: 30236083 PMCID: PMC6149054 DOI: 10.1186/s12885-018-4786-7] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.
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Affiliation(s)
- Alan White
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK.
| | - Lucy Ironmonger
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Robert J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, DD1 9SY, UK
| | - Nick Ormiston-Smith
- Department of Health, 15 Butterfield Street, Herston, Brisbane, 4006, QLD, Australia
| | - Carina Crawford
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Amanda Seims
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK
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13
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Uptake of the English Bowel (Colorectal) Cancer Screening Programme: an update 5 years after the full roll-out. Eur J Cancer 2018; 103:267-273. [PMID: 30196989 PMCID: PMC6202675 DOI: 10.1016/j.ejca.2018.07.135] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 02/06/2023]
Abstract
Background The initial roll-out of the English Bowel (Colorectal) Cancer Screening programme, during 2006 and 2009, found uptake to be low (54%) and socially graded. The current analysis used data from 2010 to 2015 to test whether uptake is increasing and becoming less socially graded over time. Methods Postcode-derived area-level uptake of 4.4 million first-time invitees, stratified by gender and the year of the first invitation (2010–2015), was generated using the National Bowel Cancer Screening System. Data were limited to people aged 60–64 years. Binomial regression tested for variations in uptake by the year of invitation, gender, region, area-based socio-economic deprivation and area-based ethnic diversity. Results Overall, the first-time colorectal cancer (CRC) screening uptake across 6 years was 52% (n = 2,285,996/4,423,734) with a decline between 2010 and 2015 (53%, 54%, 52%, 50%, 49%, 49% respectively). Uptake continued to be socially graded between the most and the least deprived area-level socio-economic deprivation quintiles (43% vs 57%), the most and the least area-based ethnic diversity quintiles (41% vs 56%) and men and women (47% vs 56%). Multivariate analysis demonstrated the effects of year, deprivation, ethnicity and gender on uptake. The effect of deprivation was more pronounced in the most deprived area quintile between men and women (40% vs 47%) than the least deprived area quintile (52% vs 62% respectively). Conclusion We did not find evidence of change in uptake patterns in CRC screening since its initial launch 10 years ago. The programme is unlikely to realise its full public health benefits and is en route to widening inequalities in CRC outcomes. Colorectal cancer screening uptake among first-time invitees remains low at 52%. There is a worrying reduction in colorectal cancer screening uptake between 2010 and 2015. There is no evidence that the social inequalities in uptake have reduced over time. There is no evidence of diffusion of innovation in colorectal cancer screening uptake in England.
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14
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Morling JR, Barke AN, Chapman CJ, Logan RF. Could stool collection devices help increase uptake in bowel cancer screening programmes? J Med Screen 2018; 25:174-177. [DOI: 10.1177/0969141317753463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective To understand the usage and acceptability of a faecal collection device amongst participants in the National Health Service Bowel Cancer Screening Programme, with the aim of influencing future uptake. Setting Participants completing faecal occult blood test retests as part of the routine Bowel Cancer Screening Programme in Eastern England. Methods A faecal collection device and questionnaire were sent to all potential retest participants during a one-month period to collect information on prior stool collection methods and ease of use and usefulness of the enclosed faecal collection device. Results Out of 1087 participants invited, 679 (62.5%) returned their questionnaire. Of these, 429 (63.2%) trialled the faecal collection device at least once, 163 (38.4%) found the device made collecting their sample easier than previously, 189 (44.6%) found it made collection more difficult and 72 (17.0%) said it made no difference. Similar numbers reported finding that the faecal collection device made collecting the sample more pleasant (130, 31.5%), less pleasant (103, 25.0%) and no different (179, 43.4%) compared with previous collection without a faecal collection device. Conclusion Although a small proportion of participants found the faecal collection device helpful, a considerable majority did not or did not use it at all. Offering faecal collection devices is unlikely to produce a substantial increase in bowel cancer screening uptake.
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Affiliation(s)
- JR Morling
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - AN Barke
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
| | - CJ Chapman
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
| | - RF Logan
- Bowel Cancer Screening Programme (Eastern Hub), Queens Medical Centre, Nottingham, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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15
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Marlow LAV, Chorley AJ, Haddrell J, Ferrer R, Waller J. Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women. Eur J Cancer 2017; 80:30-38. [PMID: 28535495 PMCID: PMC5489076 DOI: 10.1016/j.ejca.2017.04.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Uptake of cervical cancer screening in the United Kingdom (UK) is falling year on year, and a more sophisticated understanding of non-participation may help design interventions to reverse this trend. This study ascertained the prevalence of different non-participant types using the Precaution Adoption Process Model (PAPM). METHODS Home-based computer-assisted interviews were carried out with 3113 screening-eligible women in Britain. Survey items assessed self-reported screening uptake and intention to attend in future. Responses to these items were used to classify women into one of five different types of non-participants. RESULTS Of 793 non-participants, 28% were unaware of screening, 15% had decided not to attend and 51% were intending to have screening but were currently overdue. Younger women were more likely to be unaware of screening or to intend to be screened, while older women were more likely to have decided not to be screened. Women from ethnic minority backgrounds were more likely to be unaware of screening than white women. Being in a lower social grade was associated with increased odds of all three types of non-participation. CONCLUSION The majority of cervical cancer screening non-participants are not making an active decision not to attend but rather are either unaware or unable to act. There are clear sociodemographic differences between non-participant types, which could be used to identify where tailored interventions may be best targeted.
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Affiliation(s)
- Laura A V Marlow
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Amanda J Chorley
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jessica Haddrell
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Rebecca Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jo Waller
- Cancer Communication & Screening Group, Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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16
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Hirst Y, Skrobanski H, Kerrison RS, Kobayashi LC, Counsell N, Djedovic N, Ruwende J, Stewart M, von Wagner C. Text-message Reminders in Colorectal Cancer Screening (TRICCS): a randomised controlled trial. Br J Cancer 2017; 116:1408-1414. [PMID: 28441381 PMCID: PMC5520096 DOI: 10.1038/bjc.2017.117] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We investigated the effectiveness of a text-message reminder to improve uptake of the English Bowel Cancer Screening programme in London. METHODS We performed a randomised controlled trial across 141 general practices in London. Eight thousand two hundred sixty-nine screening-eligible adults (aged 60-74 years) were randomised in a 1 : 1 ratio to receive either a text-message reminder (n=4134) or no text-message reminder (n=4135) if they had not returned their faecal occult blood test kit within 8 weeks of initial invitation. The primary outcome was the proportion of adults returning a test kit at the end of an 18-week screening episode (intention-to-treat analysis). A subgroup analysis was conducted for individuals receiving an invitation for the first time. RESULTS Uptake was 39.9% in the control group and 40.5% in the intervention group. Uptake did not differ significantly between groups for the whole study population of older adults (adjusted odds ratio (OR) 1.03, 95% confidence interval (CI) 0.94-1.12; P=0.56) but did vary between the groups for first-time invitees (uptake was 34.9% in the control and 40.5% in the intervention; adjusted OR 1.29, 95% CI 1.04-1.58; P=0.02). CONCLUSIONS Although text-message reminders did not significantly increase uptake of the overall population, the improvement among first-time invitees is encouraging.
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Affiliation(s)
- Yasemin Hirst
- The Research Department of Behavioural
Science and Health, University College London, Gower
Street, London
WC1E 7BT, UK
| | - Hanna Skrobanski
- The Research Department of Behavioural
Science and Health, University College London, Gower
Street, London
WC1E 7BT, UK
| | - Robert S Kerrison
- The Research Department of Behavioural
Science and Health, University College London, Gower
Street, London
WC1E 7BT, UK
| | - Lindsay C Kobayashi
- The Research Department of Behavioural
Science and Health, University College London, Gower
Street, London
WC1E 7BT, UK
- Center for Population and Development
Studies, Harvard T. H. Chan School of Public Health, Harvard University,
Cambridge, MA
02138, USA
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer
Trials Centre, Cancer Institute, University College London, 90
Tottenham Court Road, London
W1T 4TJ, UK
| | - Natasha Djedovic
- St Marks Bowel Cancer Screening Centre,
St Marks Hospital, Watford Road, Harrow,
Middlesex
HA1 3UJ, UK
| | - Josephine Ruwende
- NHS England London Region,
Southside, 105 Victoria Street, London
SW1E 6QT, UK
| | - Mark Stewart
- St Marks Bowel Cancer Screening Centre,
St Marks Hospital, Watford Road, Harrow,
Middlesex
HA1 3UJ, UK
| | - Christian von Wagner
- The Research Department of Behavioural
Science and Health, University College London, Gower
Street, London
WC1E 7BT, UK
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17
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Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2016; 24:127-145. [PMID: 27754937 PMCID: PMC5542134 DOI: 10.1177/0969141316664757] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Screening participation is spread differently across populations, according to factors such as ethnicity or socioeconomic status. We here review the current evidence on effects of interventions to improve cancer screening participation, focussing in particular on effects in underserved populations. Methods We selected studies to review based on their characteristics: focussing on population screening programmes, showing a quantitative estimate of the effect of the intervention, and published since 1990. To determine eligibility for our purposes, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search and expanded this until the search yielded eligible papers on title review which were less than 1% of the total. We classified the eligible studies by intervention type and by the cancer for which they screened, while looking to identify effects in any inequality dimension. Results The 68 papers included in our review reported on 71 intervention studies. Of the interventions, 58 had significant positive effects on increasing participation, with increase rates of the order of 2%–20% (in absolute terms). Conclusions Across different countries and health systems, a number of interventions were found more consistently to improve participation in cancer screening, including in underserved populations: pre-screening reminders, general practitioner endorsement, more personalized reminders for non-participants, and more acceptable screening tests in bowel and cervical screening.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan P Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abeera Mohammad
- Centre for Cancer Prevention, 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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