The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England

OBJECTIVE

To raise compliance in a general practice based colorectal cancer screening programme by the use of a simple health educational leaflet.

DESIGN

A randomised controlled trial of the leaflet's effect on completion of faecal occult blood tests. The leaflet explained the high frequency of colorectal cancer, the principles of screening, and addressed reasons for non-compliance.

SETTING

The British town of Market Harborough where most of the population are registered with a single practice.

PARTICIPANTS

These comprised 1571 residents aged 61 to 70 years registered with the practice. Residents were invited to receive a free faecal occult blood test in a colorectal cancer screening programme. Half the population were randomly assigned to receive the educational leaflet about screening.

RESULTS

Compliance in test and control groups, positive rate of stool testing, and pathology detected were measured. Compliance was higher in men who received the leaflet in those aged 61 to 65 years (36% v 27%, chi2 = 4.0, p < 0.05) and in men aged 66 to 70 years (39% v 23%, chi2 = 9.7, p < 0.01). In women, use of the leaflet did not affect compliance in those aged either 61 to 65 years (38% v 36%, chi2 = 0.1, NS) or 66 to 70 years (31% v 31%, chi2 = 0.0, NS). The positive rate of stool testing in patients observing the required dietary restrictions was 1.6%. A significant lesion was detected in 1.4% of people tested (2 carcinomas and 5 patients with adenomatous polyps).

CONCLUSIONS

Health education leaflets addressing reasons for non-compliance significantly increased compliance in men and should be used in screening programmes. Reasons for the lack of success of the leaflet in women should be investigated and other interventions for raising compliance should be developed.

Screening for colorectal cancer: reasons for refusal of faecal occult blood testing in a general practice in England

STUDY OBJECTIVE

To ascertain reasons for non-compliance with faecal occult blood tests in colorectal cancer screening programmes.

DESIGN

A standard interview by a trained nurse of a random sample of those who declined screening.

SETTING

The Leicestershire town of Market Harborough, where most of the 25,000 population are served by a single general practice of 10 partners.

PARTICIPANTS

Altogether 4185 residents aged 51 to 70 years were invited to receive a free faecal occult blood test (Haemoccult). Eighty one subjects from a sample of 351 who wrote declining the offer were interviewed.

MAIN RESULTS

Non-compliers were divided into those who did not request a test kit and those who returned an unused kit. In the former group the commonest reasons given were intercurrent illness (39%), fear of further tests and surgery (24%), and feeling well (22%). For those who returned unused kits the commonest reasons were the unpleasantness of the stool collection procedure (65%), feeling well (30%), intercurrent illness (23%), and fear of further tests and surgery (20%). In both groups the main concern of those who did not comply were fear of further diagnostic tests and surgery rather than concern at the lack of effective treatment for cancer.

CONCLUSIONS

To increase compliance, education and publicity must explain the concept of asymptomatic illness and allay people's fear of hospital investigation and treatment. The benefits of screening should be particularly emphasised to those who return kits so they may overcome their reservations.