Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study

Robert S Kerrison, Lesley M McGregor, Sarah Marshall, John Isitt, Nicholas Counsell, Jane Wardle, Christian von Wagner, Robert S Kerrison, Lesley M McGregor, Sarah Marshall, John Isitt, Nicholas Counsell, Jane Wardle, Christian von Wagner

Abstract

Background: In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include 'one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake.

Method: This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final.

Results: Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02-7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90%) indicated a preference for a same-sex practitioner, whereas three (10%) gave no preference. Preference for a same-sex practitioner was higher among women than men (χ(2)=7.78, P<0.05), with only 67% of men (six of nine) requesting a same-sex practitioner, compared with 100% of women (n=21).

Conclusions: Sending previous non-responders a 12 months' reminder letter with a brief information leaflet is a feasible and efficacious intervention, which merits further investigation in a randomised controlled trial.

Figures

Figure 1
Figure 1
BSS invitation flowchart with self-referral reminder added.
Figure 2
Figure 2
Basic design of the study.

References

    1. A'Hern R (2001) Sample size tables for exact single-stage phase II designs. Stat Med 20(6): 859–866.
    1. Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, Parkin DM, Wardle J, Duffy SW, Cuzick J (2010) Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375(9726): 1624–1633.
    1. Babbie E (2011) The Practice of Social Research 12th edn, p 212. Wadsworth: Belmont.
    1. Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31(2): 143–164.
    1. Baron RC, Rimer BK, Breslow RA, Coates RJ, Kerner J, Melillo S, Habarta N, Kalra GP, Chattopadhyay S, Wilson KM (2008) Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening: a systematic review. Am J Prev Med 35(1): S34–S55.
    1. Cancer Research UK (2014) Saving lives, averting costs: an analysis of the financial mplications of achieving earlier diagnosis of colorectal, lung and ovarian cancer. Available from (accessed 14 September 2015).
    1. Cancer Research UK (2015. a) Bowel Cancer Incidence Statistics. Available from (accessed 14 September 2015).
    1. Cancer Research UK (2015. b) Bowel Cancer Mortality Statistics. Available from (accessed 14 September 2015).
    1. Cancer Research UK (2015. c) Bowel Cancer Survival Statistics. Available from (accessed 14 September 2015).
    1. Department for Communities and Local Government (2010) English indices of deprivation 2010. Available from (accessed: 10 July 2015).
    1. Department of Health (2012) NHS Bowel Cancer Screening Programme – Advice to the NHS Bidding Process. Available from (accessed 29 May 2015).
    1. Dillard AJ, Fagerlin A, Dal Cin S, Zikmund-Fisher BJ, Ubel PA (2010) Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening. Soc Sci Med 71(1): 45–52.
    1. Engel J (1988) Polytomous logistic regression. Stat Neerl 42(4): 233–252.
    1. Farraye FA, Wong M, Hurwitz S, Puleo E, Emmons K, Wallace MB, Fletcher RH (2004) Barriers to endoscopic colorectal cancer screening: are women different from men? Am J Gastroenterol 99(2): 341–349.
    1. General Medical Council (2008) Consent: patients and doctors making decisions together. Available from (accessed 18 November 2015).
    1. Geurts SME, Massat NJ, Duffy SW (2015) Likely effect of adding flexible sigmoidoscopy to the English NHS Bowel Cancer Screening Programme: impact on colorectal cancer cases and deaths. Br J Cancer 113(1): 142–149.
    1. Harding C, Romanou E, Williams J, Peters M (2012) The 2011 Skills for Life Survey: A Survey of Literacy, Numeracy and ICT Levels in England: Report for BIS, BIS Research Paper. Available from (accessed 7 December 2012).
    1. Hewitson P, Ward A, Heneghan C, Halloran S, Mant D (2011) Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial. Br J Cancer 105(4): 475–480.
    1. Jensen JD, King AJ, Carcioppolo N, Krakow M, Samadder NJ, Morgan S (2014) Comparing tailored and narrative worksite interventions at increasing colonoscopy adherence in adults 50–75: a randomized controlled trial. Soc Sci Med 104: 31–40.
    1. Jones RM, Woolf SH, Cunningham TD, Johnson RE, Krist AH, Rothemich SF, Vernon SW (2010) The relative importance of patient-reported barriers to colorectal cancer screening. Am J Prev Med 38(5): 499–507.
    1. Kincaid JP, Fishburne RP Jr, Rogers RL, Chissom BS (1975) Derivation of new readability formulas (automated readability index, fog count and flesch reading ease formula) for navy enlisted personnel: Research Branch Report 8-75. Memphis, TN: Naval Air Station. Available from (accessed: 7 December 2015).
    1. Kiviniemi MT, Bennett A, Zaiter M, Marshall JR (2011) Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psycho-Oncology 20(10): 1023–1033.
    1. Leslie A, Carey FA, Pratt NR, Steele RJC (2002) The colorectal adenoma–carcinoma sequence. Br J Surg 89(7): 845–860.
    1. Libby G, Bray J, Champion J, Brownlee LA, Birrell J, Gorman DR, Crighton EM, Fraser CG, Steele RJ (2011) Pre-notification increases uptake of colorectal cancer screening in all demographic groups: a randomized controlled trial. J Med Screen 18(1): 24–29.
    1. Lo SH, Halloran S, Snowball J, Seaman H, Wardle J, von Wagner C (2014) Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut 64(2): 282–291.
    1. Logan RF, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C (2012) Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 61(10): 1439–1446.
    1. McGregor LM, Bonello B, Kerrison RS, Nickerson C, Baio G, Berkman L, Rees CJ, Atkin W, Wardle J, von Wagner C (2015. a) Uptake of Bowel Scope (Flexible Sigmoidoscopy) Screening in the English National Programme: the first 14 months. J Med Screen e-pub ahead of print 20 September 2015; doi:10.1177/0969141315604659.
    1. McGregor LM, von Wagner C, Vart G, Yuen WC, Raine R, Wardle J, Robb KA (2015. b) The impact of supplementary narrative-based information on colorectal cancer screening beliefs and intention. BMC Cancer 15(1): 162.
    1. Menees SB, Inadomi JM, Korsnes S, Elta GH (2005) Women patients' preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc 62(2): 219–223.
    1. Pearson K (1900) X. On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Philosophical Magazine Series 5 50(302): 157–175.
    1. Resonant (2015) About us. Available from http://resonant.agency/about/ (accessed 10 July 2015).
    1. Robb KA, Lo SH, Power E, Kralj-Hans I, Edwards R, Vance M, von Wagner C, Atkin W, Wardle J (2012) Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK. J Med Screen 19(4): 171–176.
    1. Robb K, Power E, Kralj-Hans I, Edwards R, Vance M, Atkin W, Wardle J (2010) Flexible sigmoidoscopy screening for colorectal cancer: uptake in a population-based pilot programme. J Med Screen 17(2): 75–78.
    1. Rosenstock IM (1974) The health belief model and preventive health behavior. Health Educ Monogr 2(4): 354–386.
    1. Steele R, Kostourou I, McClements P, Watling C, Libby G, Weller D, Brewster D, Black R, Carey F, Fraser C (2010) Effect of repeated invitations on uptake of colorectal cancer screening using faecal occult blood testing: analysis of prevalence and incidence screening. BMJ 341: c5531.
    1. Varadarajulu S, Petruff C, Ramsey WH (2002) Patient preferences for gender of endoscopists. Gastrointest Endosc 56(2): 170–173.
    1. Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89(19): 1406–1422.
    1. Wardle J, Miles A, Atkin W (2005) Gender differences in utilization of colorectal cancer screening. J Med Screen 12(1): 20–27.
    1. Whyte S, Chilcott J, Halloran S (2012) Reappraisal of the options for colorectal cancer screening in England. Colorectal Dis 14(9): e547–e561.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner