The SMARTscreen Trial: A Randomised Controlled Trial Investigating The Efficacy of a GP-Endorsed Narrative SMS To Increase Participation in The Australian National Bowel Cancer Screening Program.

Abstract

Background: Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently only 44% of Australians aged 50 -74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice.Methods: We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narratives messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to twelve months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit.Discussion: This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementationTrial registration: Australian New Zealand Clinical Trials Registry: ACTRN12620001020976, 17th October 2020

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

“…A detailed trial protocol was published prior to recruitment of practices and the trial was conducted with no substantive changes to the protocol 18 . We used the CONSORT guidelines for reporting the trial 19 .…”

“…The SMARTscreen intervention was co-designed by the investigator team which included clinical, academic, consumer and industry representatives. Using existing evidence-based resources, and an iterative process, the investigator team developed an SMS which included a text message with an embedded, clickable link (a 'weblink') that opened to a customised webpage with four screens designed to increase screening 18 . Each weblink had a unique alphanumeric code to enable tracking of the number of times each webpage was opened.…”

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.

“…Short message services (SMS) are being used more often by general practice to communicate with patients because this approach provides an opportunity to reach large numbers of patients in real time and messages can be viewed discreetly multiple times at an individual's convenience and have demonstrated success at increasing screening uptake internationally (12,13). Between 2020 and 2021, we undertook a trial in 21 general practices, called SMARTscreen (14), to test an intervention which combined, in one SMS, multiple evidence-based components known to increase screening uptake including a message of endorsement from a credible source (i.e., the GP) (15), and web-links to motivational video narratives (16)(17)(18) and instructions for how to do the test. The SMS was sent to patients from their general practice just before they were due to receive their NBCSP kit.…”