Interventions to increase uptake of faecal tests for colorectal cancer screening: a systematic review

Abstract

International guidelines promote screening by faecal tests in asymptomatic individuals at average risk of colorectal cancer (CRC), but uptake does not reach recommended levels in most countries. The aim of this study was to synthetize evidence on (a) interventions aiming to increase uptake of faecal tests for CRC screening, in asymptomatic individuals at average risk of CRC, (b) interventions that targeted general practitioner (GP) involvement and (c) interventions that targeted nonresponders or disadvantaged groups. A systematic review of randomized-controlled trials, searching PubMed, Embase and the Cochrane Library database, based on the Cochrane's Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines was performed. The risk of bias of included trials was assessed. From 24 included RCTs, the following interventions increase uptake of faecal tests: advance notification letter (OR 1.20-1.51), postal mailing (OR 1.31-7.70), telephone contacts with an advisor (OR 1.36-7.72). Three interventions showed positive effects of GP involvement such as a GP-signed invitation letter [odds ratio (OR)=1.26], GP communication training (OR=1.22) or mailing reminders to GPs (OR=14.8). Inconclusive results were found for studies comparing different types of faecal tests and those testing the effectiveness of providing various types of written information. Advance notification letters, postal mailing of the faecal tests, written reminders and telephone contacts with an advisor increase patient uptake of faecal tests. There was only limited evidence on the effect of GP involvement on screening test uptake and a lack of studies focusing on nonresponders or disadvantaged groups.

Feasibility of an implementation intervention to increase attendance at diabetic retinopathy screening: protocol for a cluster randomised pilot trial

“…The current intervention was developed through a systematic multi-stage process combining theory, evidence and consultation with multiple stakeholders. Components found to improve uptake of retinopathy screening [38,43,72] and cancer screening [73][74][75][76][77][78][79][80][81][82], include audit and feedback [83], patient [73,76,77,79,[84][85][86][87][88][89][90][91] and physician [38,72] reminders, the use of trusted sources to deliver messages [37,[73][74][75] and key information leaflets [74,81,82]. Our intervention comprises these strategies.…”

Physician‐office vs home uptake of colorectal cancer screening using FOBT/FIT among screening‐eligible US adults

“…Some population‐based interventions have found FOBT/FIT to be particularly effective in boosting CRC screening uptake when kits are mailed to homes along with instructions and educational packages . Similarly, a systematic review revealed that outreach interventions including those utilizing mailed FOBT kits improved CRC screening in Canada, and several European countries . This initiative should be tested for potential scalability at the national level.…”

“…46,48,51 Similarly, a systematic review revealed that outreach interventions including those utilizing mailed FOBT kits improved CRC screening in Canada, and several European countries. 52 This initiative should be tested for potential scalability at the national level. Interventions are also needed at the level of care providers, given our finding of continued in-office screening and other studies pointing to knowledge gaps among health care providers.…”

“…20,31 Hence, educational programs that provide up-to-date guideline information and best practices pertinent to CRC screening should be offered to physicians as part of continuing medical education. At the population level, sustained implementation of educational programs may be beneficial, given that previous studies that utilized interventions such as trained community peer educators 46 and mailed educational kits, 52 documented improved screening rates. It is important to acknowledge the limitations of our study.…”

Social media and mobile health technology for cancer screening: a systematic review and meta-analysis protocol

“…Many factors can influence screening participation including best-practice guidelines, physician reimbursement models, screening modalities available, physician recommendation for screening, the infrastructure and design of the screening programme itself, and participant-level factors 10–13. Interventions designed to increase screening participation are generally expensive, challenging to implement and have limited impact 14–16…”