Methods to increase participation in organised screening programs: a systematic review

Laura Camilloni, Eliana Ferroni, Beatriz Jimenez Cendales, Annamaria Pezzarossi, Giacomo Furnari, Piero Borgia, Gabriella Guasticchi, Paolo Giorgi Rossi, Methods to increase participation Working Group, Paolo Giorgi Rossi, Antonio Federici, Livia Giordano, Carlo Senore, Teresa Spadea, Anna Iossa, Grazia Grazzini, Carla Cogo, Fabio Palazzo, Mauro Palazzi, Beatriz Jimenez, Giacomo Furnari, Laura Camilloni, Piero Borgia, Gabriella Guasticchi Laziosanità, Eliana Ferroni, Laura Camilloni, Eliana Ferroni, Beatriz Jimenez Cendales, Annamaria Pezzarossi, Giacomo Furnari, Piero Borgia, Gabriella Guasticchi, Paolo Giorgi Rossi, Methods to increase participation Working Group, Paolo Giorgi Rossi, Antonio Federici, Livia Giordano, Carlo Senore, Teresa Spadea, Anna Iossa, Grazia Grazzini, Carla Cogo, Fabio Palazzo, Mauro Palazzi, Beatriz Jimenez, Giacomo Furnari, Laura Camilloni, Piero Borgia, Gabriella Guasticchi Laziosanità, Eliana Ferroni

Abstract

Background: The European Community recommends the implementation of population-based screening programmes for cervical, breast, and colorectal cancers. This recommendation is supported by many observational studies showing that organised programmes effectively reduce mortality and control the inappropriate use of screening tests. We conducted a systematic review of studies assessing the efficacy of interventions to increase participation in organised population-based screening programs.

Methods: We included all studies on interventions aimed at increasing screening participation published between 1/1999 and 7/2012. For those published before 1999, we considered the Jepson et al. (2000) review (Health Technol Assess 4:1-133, 2000).

Results: Including studies from the Jepson review, we found 69 with quantitative information on interventions in organised screening: 19 for cervical, 26 for breast, 20 colorectal cancers, and 4 for cervical and breast cancer together.Effective interventions were: postal (breast RR = 1,37 95% Confidence Interval (95% CI): 1.25-1.51; cervical RR = 1.71 95% CI: 1.60-1.83; colorectal RR = 1.33 95% CI: 1.17-1.51) and telephone reminders (with heterogeneous methods for implementation); GP's signature on invitation letter (breast RR = 1.13 95% CI: 1.11-1.16; cervical RR = 1.20 95% CI: 1.10-1.30; colorectal RR = 1.15 95% CI: 1.07-1.24); scheduled appointment instead of open appointment (breast RR = 1.26 95% CI: 1.02-1.55; cervical RR = 1.49 95% CI: 1.27-1.75; colorectal RR = 1.79 95% CI: 1.65-1.93). Mailing a kit for self-sampling cervical specimens increased participation in non-responders (RR = 2.37 95% CI: 1.44-3.90).

Conclusion: Although some interventions did prove to be effective, some specific variables may influence their effectiveness in and applicability to organised population-based screening programs.

Figures

Figure 1
Figure 1
Flowchart of included and excluded studies.
Figure 2
Figure 2
Effect on screening program participation of mail recall in addition to invitation letter vs invitation letter alone.
Figure 3
Figure 3
Effect on screening program participation of phone call reminder in addition to invitation letter vs invitation letter and mail recall.
Figure 4
Figure 4
Effect on screening program participation of face-to-face interventions (a) and of different types of letters (b).
Figure 5
Figure 5
Effect on screening program participation of GP signature on invitation letter vs standard invitation letter.
Figure 6
Figure 6
Effect on screening program participation of printed information material (a) and of educational interventions (b).
Figure 7
Figure 7
Effect of mailing self-sampling devices to increase participation in non-responders. This method applies only to cervical and colorectal cancer with devices for HPV testing (a) and faecal occult blood testing, respectively (b).
Figure 8
Figure 8
Effect on screening program participation of scheduled appointment vs open appointment.

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Source: PubMed

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