Are Text Message Reminders an Effective Intervention for Improving the Uptake of Breast Screening?

March 11, 2021 updated by: Imperial College Healthcare NHS Trust

A Randomised Controlled Trial Investigating the Efficacy and Effectiveness of Text Message Reminders to Improve Uptake of Breast Screening by Prevalent Women Living in the London Borough of Hillingdon

Breast Cancer is the single most common cancer, and the third leading cause of cancer cancer deaths, in the United Kingdom. Breast screening is able to detect breast cancer in the early stages of development, during which time it is more easily treatable. Unfortunately, many patients do not attend screening, and surveys issued to these women consistently report "forgetfulness" as the primary reason for missing the appointment. Both telephone reminders and postal reminders have been shown to reduce non-attendance, however, these are time consuming and expensive.

Mobile telephones are becoming an increasingly popular tool for communication between healthcare professionals and patients, one which might offer an inexpensive solution for delivering reminders. Text message reminders have been able to prevent missed appointments in other areas of healthcare, and the same might be true for breast screening.

The investigators are conducting a trial to confirm whether this is the case or not.

In this trial, the investigators will send some women a text message to reminder them of their appointment, and other women no reminder for their appointment. The investigators will then compare the number of women in each group that went to their breast screening appointment.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Breast cancer is the single most common cancer in the United Kingdom, accounting for 16% of all cancer incidences and 7% of all cancer deaths. Fortunately, the natural progression of this malignancy can be beneficially changed through mammographic screening techniques, which enable early detection and treatment of benign and malignant breast disease. However, the success of screening programmes depends not only on the analytical specificity and sensitivity of the screening test itself, but also its ability to attract the "at risk" population. In the United Kingdom, the National Health Service Breast Screening Programme attracts about three quarters of the invited population every three years. In the last screening round (2007-2010), all but one region reported a triennial coverage of more than 75%; London was the exception, reporting a regional coverage of 69%. London consistently fails to meet the national target.

Missed appointments are a primary cause of inefficiency in healthcare delivery, with adverse clinical implications for the non-attending patient, and substantial monetary costs to the health service. To ensure the future success of the breast screening programme it is imperative that strategies for improving uptake of hard to reach populations be developed. Research has demonstrated that receiving an appointment reminder by text message has been successful in improving uptake in other areas of healthcare; the same might be true for breast screening.

Primary Aim: To establish whether text message reminders can significantly improve the uptake of breast screening by women on an "intention-to-treat" basis in the London Borough of Hillingdon.

Secondary Aim: To evaluate whether text message reminders are an effective intervention for improving uptake of the breast screening programme by hard to reach patients such as women living in deprived areas, and those of Black and Minority ethnic backgrounds.

Methodology: A single blind randomised controlled trial evaluating the effectiveness, efficacy, and acceptability of sending a text message appointment reminder to prevalent women (women aged 47-53 years) living in the London Borough of Hillingdon 48 hours prior to their first breast screening appointment. 2,239 women without a history of breast screening, implant, or bilateral mastectomy were included in the study and randomly assigned in a 1:1 ratio to either the control group (n= 1,118) or the intervention group (n= 1,121). Women in the control group were invited to screening but received no reminder for their appointment, whilst women in the intervention group received a text message reminder 48 hours in advance. All women received an information letter about the study with their invitation from the West of London Breast Screening Service, which included a patient "opt-out" request form. Patients were not told whether they would be receiving a text message reminder or not. iPlato Patient Care Messaging was used to deliver the text-message reminders.

Study Type

Interventional

Enrollment (Actual)

2240

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
    • London
      • Hammersmith, London, United Kingdom, W6 8RF
        • Charing Cross Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

47 years to 53 years (Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

Women aged 47-53 years, being invited for their first breast screen, without a history of breast disease or malignancy, living in the London Borough of Hillingdon, were eligible for inclusion in the trial.

Exclusion Criteria:

Women with a history of breast disease, malignancy, bi-lateral mastectomy, or breast screen, aged over 54 years were not eligible for inclusion in the trial. Non-routine appointments, male appointments, and self referrals were also not eligible for inclusion.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: No Text Message Reminder (Control) Arm
Control Arm, in which patients are invited to breast screening as per standard West of London Breast Screening Protocol (i.e. without a text message appointment reminder). Uptake of breast screening in this group will be compared with the text message reminder group to test for significant differences.
Experimental: Text Message Reminder Arm
Patients randomly allocated to this arm of the study will be sent a text message reminding them of the time, date and venue of their breast screening appointment 48 hours in advance.
Other: Text Message Reminder for Breast Screening Appointment
Non-clinical/administrative.
Other Names:
  • iPlato Patient Care Messaging will be used to send the text message reminder to the patient.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Attendance at Breast Screening
Time Frame: The text message was sent 48 hours before the appointment, attendance was assessed 60 days after the appointment date.
Number of women that participate in breast screening in the control (no text message reminder) compared with the number of women that participate in the intervention (text message reminder 48 hours before appointment).
The text message was sent 48 hours before the appointment, attendance was assessed 60 days after the appointment date.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mobile Prevalence
Time Frame: The accuracy of patient mobile records was assessed for the intervention group at the time the text reminder was sent (i.e. 48 hours before the appointment). A check for the control group was performed at the same time.
Number of women with a valid mobile telephone number on the GP Clinical System
The accuracy of patient mobile records was assessed for the intervention group at the time the text reminder was sent (i.e. 48 hours before the appointment). A check for the control group was performed at the same time.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Imperial College Healthcare NHS Trust

Investigators

  • Study Chair: Ellis Friedman, FFPH, London Borough of Sutton
  • Study Chair: Heema Shukla, PhD, Public Health England
  • Study Chair: Deborah Cunningham, MBBS, Imperial College Healthcare NHS Trust
  • Principal Investigator: Robert S Kerrison, BSc, Imperial College Healthcare NHS Trust

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2012

Primary Completion (Actual)

November 1, 2013

Study Completion (Actual)

November 1, 2013

Study Registration Dates

First Submitted

October 9, 2013

First Submitted That Met QC Criteria

October 31, 2013

First Posted (Estimate)

November 6, 2013

Study Record Updates

Last Update Posted (Actual)

April 6, 2021

Last Update Submitted That Met QC Criteria

March 11, 2021

Last Verified

March 1, 2021

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 7114/P21R
  • 12/EM/0418 (Other Identifier: NRES Committe East Midlands - Derby)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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