Randomised trial of compliance with screening for colorectal cancer.

Abstract

A randomised trial of compliance with screening for colorectal cancer by means of the haemoccult test was conducted in Farnborough and Basingstoke districts. In each of the 14 participating practices (41 general practitioners) 25 852 men and women aged between 40 and 70 years were randomly allocated by household to one of six groups. The group determined the method of invitation to screening: a letter and the test were sent to the patient, or a letter with an appointment to attend the surgery was sent, or during a routine consultation the general practitioner invited patients to participate, and some patients received an educational booklet about bowel disorders and screening. Of the 17 824 people who were offered screening, 7545 (42%) complied. Compliance was significantly affected by the method of invitation, but not by whether an educational booklet was received, and was highest (57%) in the group that was offered the haemoccult test during a routine consultation (the "opportunistic" approach). In this group the compliance rate achieved by individual general practitioners ranged from 26% to 82%. Compliance was significantly higher in Farnborough, in the older (55-70) age group, in women, and in households in which two or more people were offered screening. The higher compliance in Farnborough may be explained by the higher proportion of older people and by the higher proportion of people living in households of two or more in the population that was offered screening. The fact that the screening programme in Farnborough was offered to the whole community and that the researcher may have acted as a facilitator were probably also important. One per cent of the patients screened had a positive test, and 24 (38%) of the 63 patients who were positive and were investigated in hospital had neoplastic disease. The yield was 1.2 cancers and 1.2 benign adenomas (1 cm or larger in size) per 1000 people screened. This low yield is likely to be a consequence of the relatively young age group screened.

The Role of GPs in Increasing Compliance to Colorectal Cancer Screening: A Randomised Controlled Trial (Italy)

“…Few randomised trials have been conducted to evaluate the effectiveness of intervention in increase compliance to CRCS with FOBT [15][16][17][18][19][20][21][22], and only two involved a GP reminder as intervention [22,23].…”

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

“…230 Three trials of mailed materials focusing on barriers to screening uptake reported an increase in uptake: one in FS screening 231 and two in gFOBt screening. 178,232 Two other trials observed no effect 37,233 and one saw reduced uptake with mailed materials. 234 A recent US-based study also failed to demonstrate a statistically significant increase in uptake associated with adding an educational pamphlet, video and simplified gFOBt kit instruction sheet to usual care materials.…”

The pros and cons of fecal occult blood testing for colorectal neoplasms

“…Even among some physicians there is limited appreciation of the disease and of the potential importance of a positive occult blood test [139][140][141][142]. Thus it is not surprising that success in obtaining patient cooperation varies considerably among individual physicians [143]. Although most doctors apparently agree with the American Cancer Society's guidelines for colorectal screening, only a minority actually follows them in clinical practice ]139].…”

“…132,135, 146], although not all [136,143], indicate that elderly patients have the lowest compliance with occult blood testing. This is a major blow to the screening concept, since the risk of bowel cancer [101], the likelihood of a positive test [102], and the predictive value of a positive result [102] all progressively increase with age.…”