SMARTERscreen protocol: a three-arm cluster randomised controlled trial of patient SMS messaging in general practice to increase participation in the Australian National Bowel Cancer Screening Program

Abstract

Background Australia persistently has one of the highest rates of colorectal cancer (CRC) in the world. Australia’s National Bowel Cancer Screening Program (NBCSP) sends a biennial Faecal Immunochemical Test (FIT)—the ‘NBCSP kit’—to everyone eligible for the programme between 50 and 74 years old; however, participation in the programme is low, especially in the 50- to 60-year-old age group. Our previous efficacy trial (‘SMARTscreen’) demonstrated an absolute increase in uptake of 16.5% (95% confidence interval = 2.02–30.9%) for people sent an SMS with motivational and instructional videos, from their general practice prior to receiving their NBCSP kit, compared to those receiving usual care. Building on the strengths of the SMARTscreen trial and addressing limitations, the ‘SMARTERscreen’ trial will test the effect on participation in the NBCSP of sending either an SMS only or an SMS with online video material to general practice patients due to receive their NBCSP compared to ‘usual care’. Methods SMARTERscreen is a three-arm stratified cluster randomised controlled trial involving 63 general practices in two states in Australia. Eligible patients are patients who are aged 49–60 years and due to receive their NBCSP kit within the next 2 weeks during the intervention period. General practices will be equally randomised to three trial arms (21:21:21, estimated average 260 patients/practice). The two interventions include (i) an SMS with an encouraging message from their general practice or (ii) the same SMS with weblinks to additional motivational and instructional videos. The control arm will receive ‘usual care’. Using the intention-to-treat approach, primary analysis will estimate the three pair-wise between-arm differences in the proportion of eligible patients who participate in the NBCSP within 6 months of when their kit is sent, utilising screening data from the Australian National Cancer Screening Register (NCSR). Patient intervention adherence to the interventions will also be evaluated. Findings will be incorporated into the Policy1-Bowel microsimulation model to estimate the long-term health benefits and cost-effectiveness of the interventions. Discussion SMARTERscreen will provide high-level evidence determining whether an SMS or an SMS with web-based material sent to general practice patients prior to receiving their NBCSP kit increases participation in bowel cancer screening. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12623000036617. Registered on 13 January 2023. Trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385119&isClinicalTrial=False

The implementation and mechanisms of advance notification for cancer screening: A scoping review

“…In fact, text message advance notifications delivered by general practitioners to encourage bowel cancer screening show promise for increasing participation in national programs. 62,63 In general, digital advance notifications, such as text messages and emails are highly efficient, convenient, and have widespread reach for promoting screening. While the effect of the four digital notifications captured in this review was mixed, 12,34,41,43 text message reminders (i.e., sent post-screening invitation) have been consistently shown to increase uptake of breast, bowel, and cervical screening, [64][65][66][67] suggesting that the use of electronic notifications may be a viable alternative to the dominant postal mail format.…”

“…For example, general practitioners are well placed to facilitate advance notification of cancer screening opportunities to their patients. In fact, text message advance notifications delivered by general practitioners to encourage bowel cancer screening show promise for increasing participation in national programs 62,63 . In general, digital advance notifications, such as text messages and emails are highly efficient, convenient, and have widespread reach for promoting screening.…”

Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.

“…The authors are addressing these limitations by using data from the newly established National Cancer Screening Register in a follow-on trial: SMARTERscreen. 28 This trial is developing methods for collecting de-identified individual-level data directly from the register to ensure that the SMS is sent at the right time and the data collected are more complete; in this way, more-granular data can be provided about individual responses to the SMS, and it should be possible to ascertain the number of individuals with a FIT result, as recorded in the register.…”

“…The Australian National Health and Medical Research Council has funded a trial with a larger population as a direct result of the study reported here. The new trial, SMARTERscreen, 28 will capture data using the new National Cancer Screening Register to provide complete datasets, along with patient characteristics such as age, sex, and location, to provide more individualised results. This will allow for a more-tailored or targeted approach to screening to be provided and, potentially, for there to be a focus on specific groups that currently under-screen.…”