Effectiveness of a brief phone intervention to increase participation in a population‐based colorectal cancer screening programme: a randomized controlled trial

Abstract

Aim Although colorectal cancer (CRC) screening reduces mortality and morbidity the uptake in target populations is suboptimal. The aim was to assess whether adding a brief phone intervention to the usual invitation process increases participation in a CRC screening programme based in Catalonia. Method This was a non‐blinded prospective randomized control study of patients eligible for their first CRC screening test (immunochemical faecal occult blood test). Between March and December 2017, 512 invitees (age range 50–69 years) were randomized to receiving either a brief informative phone call prior to receiving the standard screening invitation (letter and informative brochure) or the standard screening invitation alone. The primary outcome was participation in the screening programme at 6 months. Results In all, 492/512 patients (54.7% women; 45.3% men) could be analysed (239/256 intervention group; 253/256 control group). On an intention to treat basis, the intervention group (55% women; 45% men) saw an 11% increase in the participation rate (51.05% vs 40.32%, P = 0.017). The intervention was more effective in male patients (50.93% vs 33.91%, P = 0.01) and those patients aged between 50 and 54 years (54.32% vs 37.77%, P = 0.03). After adjusting for sex, age and geographic area, the benefit of the intervention remained statistically significant (adjusted OR 1.54, 95% CI 1.07–2.20). Conclusion Our data suggest that a brief, informative intervention by phone in addition to the usual invitation process is effective in increasing participation in a CRC screening programme. It may be a useful strategy to improve uptake in groups which are less likely to participate in CRC screening (http://clinicaltrials.gov NCT03082911).

The Effects of Different Invitation Schemes on the Use of Fecal Occult Blood Tests for Colorectal Cancer Screening: Systematic Review of Randomized Controlled Trials

“…Quality assessment with the RoB 2 tool resulted in a low risk of bias for 14 studies [10,11,13,14,16,19,26,28,32,34,[38][39][40]42], 19 studies with some concerns [12,15,17,18,[20][21][22][23][24][25]27,[29][30][31]33,36,37,41,43], and one [35] at high risk of bias (Table S1). Concerns were mainly due to the ambiguity of randomization and baseline characteristics (domain 1 "randomization process"), and a lack of pre-specified protocol or analysis plan (domain 5 "selection of the reported result").…”

“…Most studies were from population-based settings (n = 19) (Table 1), where service organizations mainly sent the invitations. Ten were performed in national screening programs [10][11][12][13][14][15][16][17][18][19], and nine in other population-based settings (e.g., within a specific region or health maintenance organization) [20][21][22][23][24][25][26][27][28]. Primary care settings (n = 7) included practices [29,30], clinics [31], university clinics [32,34], or health centers [33,35], and most invitations were sent on behalf of the physicians.…”

“…Primarily, the health system sent the invitation. In most studies, no invitation was sent to individuals with recent screening activities, e.g., gFOBT/FIT in the past year, endoscopic screening within up to 10 years [13,16,19,[23][24][25][26]28,32,[34][35][36][37][38][39][40][41][42][43], or (family-) history of CRC or other severe medical issues [10,15,16,19,[23][24][25]28,29,[32][33][34][36][37][38][39][40][41][42][43]. Main results are presented by different intervention approaches in Figures 2 and 3, and by different settings in Tables S2-S5.…”

“…Advance notification was investigated in five population-based studies [11,15,19,22,25] (Tables S2 and S3), and consistently resulted in increased usage (Figure 2). Selva et al [19] found an increase of 10.8% points by calling participants in advance to the standard national invitation procedure.…”

Invitation for colorectal cancer screening or forced marketing?

“…The claim that adding a brief phone intervention to the usual invitation process for the colorectal cancer (CRC) screening programme may be a useful strategy to improve uptake in groups that are less likely to participate merits further discussion.…”