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Using text message reminders and culturally-tailored telephone calls to promote participation in bowel cancer screening (TOPPS)

ABSTRACT: Background and study aims Bowel cancer is a leading cause of cancer-related death in England. Several large studies have shown that screening can improve bowel cancer outcomes by detecting cases early. In light of this, NHS England initiated a national bowel cancer screening programme (BCSP) in 2006. Since then, uptake has been consistently low, falling from 54% in 2010 to 49% in 2015. Further, in London, participation in bowel cancer screening is particularly low in regions where there is high ethnic diversity. However, previous research suggests that it is possible to improve screening uptake by using text message reminders and patient navigation (one-to-one support and guidance for patients throughout their decision-making regarding screening). This study aims to compare the effectiveness, and cost-effectiveness, of these two strategies to increase bowel cancer screening participation in six areas in London, where screening uptake is known to be low. This will provide policy-decision makers with the information needed to commission these services. Who can participate? Men and women aged 60-74 years registered with a participating general practice located within the London Boroughs of Brent, Ealing, Lambeth, Lewisham, Redbridge and Barking and Dagenham, who have not returned a bowel cancer screening kit within 13 weeks of delivery What does the study involve? Over a 4-week period, participants will be allocated (at random) to groups receiving either usual care, text message reminders at 13, 15, 17,19 weeks of non-response, or a text message reminder at 13 weeks plus patient navigation at 15, 17, 19 weeks of non-response.

DISEASE(S): Bowel Cancer Screening

PROVIDER: 48380 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Background and study aims Colorectal cancer (CRC, also known as bowel cancer) is the fourth most common cancer and the second leading cause of cancer related deaths in England. Screening the at risk population for CRC by way of biennial faecal occult blood testing (FOBt) reduces CRC deaths by detecting CRC early, at a time when it is easier to treat. In England, the National Health Service (NHS) runs an organised population-based CRC screening programme (Bowel Cancer Screening Programme, BCSP), which offers biennial screening via guaiac-based faecal occult blood testing (gFOBt) to any men and women aged 60-74. With 54% overall uptake, CRC screening has the lowest uptake rate amongst all of the organised National Cancer Screening Programmes (Breast and Cervical Cancer Screening) in England. As such, there is an important need for interventions to promote uptake of FOBt in the capital to reduce inequalities in uptake. Increasing evidence demonstrates that General Practitioner (GP) endorsement promotes CRC screening uptake and there is a growing interest in the use text-message reminders to increase participation in cancer screening. The present study aims to investigate the effectiveness of a primary care based text-message reminder to promote CRC screening uptake in London. Who can participate? Adults aged between 60 to 75 who are eligible for bowel cancer screening. What does the study involve? Participants are randomly allocated to one of two groups. Participants are sent an invitation letter with screening information booklet by their local Hub. They then receive the gFOBt kit and instructions 8-10 days letter. They are asked to collect samples of three separate bowel motions and send the completed kit back to the hub. A letter is sent after four weeks of non-response. Those allocated to the first group receive a text message reminder to send their kit back. Those in the second group receive the standard screening materials. Uptake in both groups will be measured at 18 weeks and compared for statistically significant differences.

Project description:Colorectal cancer (CRC) screening can reduce cancer deaths. However, screening and abnormal test follow-up rates are low among underserved populations. The screening rates of 19-58%, and rates of colonoscopy completion after abnormal stool tests of 18-57% in community health centers (CHC) systems are low. This highlights an opportunity to improve early detection and decrease burden of CRC in our region. Mailed outreach and navigation programs have been shown to increase colonoscopy completion rate. The next step is to understand how to best implement these programs in the community on a larger scale. To achieve this goal, the investigators propose a Hub-and-Spoke intervention combining centralized strategies to maximize CRC screening, follow-up, and referral-to-care. The investigators hypothesize that this intervention will be superior to usual care for increasing CRC screening, abnormal test follow-up, and referral-to-care. The investigators will conduct a randomized trial to determine effectiveness in: 1) improvement in proportion of individuals up-to-date with screening 3 years post implementation; 2) proportion with abnormal FIT who complete diagnostic colonoscopy within 6 months; and 3) proportion with CRC completing first treatment evaluation. The investigators will also evaluate the implementation, scalability, and sustainability of the multi-level implementation strategy. The intervention consists of: Mailed FIT and Reminders. Eligible individuals will receive an introductory letter describing the importance of CRC screening and noting that follow-up mail will include a FIT Kit. It will also be offered to patients who completed prior mailed FIT with normal test results. All materials will be in English and Spanish. Two weeks later, participants will receive a packet via mail containing the FIT kit, a one-page invitation inviting FIT completion and FIT instructions, a postage-paid envelope for return to the patient’s CHC, and COVID-19 message. For non-compliant individuals not returning the kit, a reminder phone call and text message will be delivered 2 weeks later. The investigators will track returned letters, individuals who are later found to be up-to date with screening, and those who decline screening. The CHC will provide care coordination for patients with an abnormal FIT result.

Project description:Background and study aims: Colorectal (bowel) cancer is the second leading cause of cancer death in the UK, and costs the National Health Service (NHS) more than £300 million a year in treatment costs. Patient survival could be increased and, costs very much reduced, if patients with bowel cancer received their diagnosis earlier, allowing treatment to begin earlier. The NHS Bowel Cancer Screening Programme (NHSBCSP) was introduced in England in 2006, and aims to screen men and women aged between 60 to 74 years of age for bowel cancer every two years using the faecal occult blood test (FOBt). Initial studies have shown that bowel screening is effective, but the number of patients who participate in screening have been quite low, with only around half of all the people who are invited to participate returning their FOBt kit. The success of the NHSBCSP relies on a high number of patients participating, and the development of new ways to improve the number participating after they are invited to participate. The main aim of the study is to assess how effective a GP reminder and additional FOBt kit are on increasing the number who participate in bowel cancer screening, when they have not participated following a previous invitation. Who can participate? All adults eligible for bowel screening (aged between 60 to 74 years old). These were patients at a participating general practice in the West Midlands, where the screening rate is less than 50%. These patients had been invited to participate in bowel screening but had not returned their FOBt within 13 weeks of initial invitation by the Midlands and North West Bowel Cancer Screening Hub. What does the study involve? We will randomly allocate the participants to one of two groups: 1. GP reminder to participate in bowel screening and additional FOBt kit, OR 2. No additional contact We compared how may people participated in bowel screening after 13 weeks. This was measured by the number of FOBt kits that were returned to the bowel screening hub by patients in each group. This allowed us to assess if the GP reminder to participate in bowel screening and additional FOBt kit was successful in increasing the participation in bowel screening. A small interview was carried out with some patients who received the GP reminder who returned a FOBt kit.

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Using text message reminders and culturally-tailored telephone calls to promote participation in bowel cancer screening (TOPPS)

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