A comparison of methods for increasing compliance within a general practitioner based screening project for colorectal cancer and the effect on practitioner workload.

Pye, Geoffrey W.; Christie, Morag; Chamberlain, Jocelyn; Moss, Susan; Hardcastle, J. D.

doi:10.1136/jech.42.1.66

Cited by 47 publications

(27 citation statements)

References 15 publications

(2 reference statements)

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“…Nicholls et al (1986) compared different methods of invitation to do a Haemoccult test and found that acceptance was greatest (57%) among people offered the test during a consultation with their general practitioner, but was only 38% when the test was sent by post. Inclusion of an educational leaflet made no difference, a fact also confirmed in Nottingham (Pye et al, 1988). In Dijon, administration of the test by a doctor also achieved higher response (57%) than when it was mailed (40%).…”

supporting

confidence: 48%

Is screening for colorectal cancer worthwhile?

Chamberlain

1990

Br J Cancer

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The well-recognised adenomacarcinoma sequence in the natural history of large bowel cancer suggests that this is a malignancy likely to be susceptible to screening. Detection and removal of precancerous adenomas and early invasive carcinomas should lead to a reduction in incidence and mortality respectively. Moreover the disease itself and the methods of testing for it fulfil many of the criteria required before implementation of a public health screening programme (Wilson & Jungner, 1968 Hardcastle, 1985).Another criterion for screening is that the natural history of the disease should be understood. This requirement is not fully met in the case of colorectal cancer or, for that matter, for any other malignant disease. Nevertheless it is known that at least some carcinomas of the large bowel develop within polypoid adenomas, and that increasing size of adenomas and a villous, as opposed to tubular, histology indicate increasing likelihood of malignancy (Morson, 1976). This implies a progression of epithelial changes of increasing severity over time. The great majority of adenomas, however, do not progress to malignancy, as shown by the prevalence of adenomas found at autopsy of people who died from other causes. One study (Vatn & Stalsberg, 1982) estimated that the autopsy prevalence of large bowel adenomas was ten times higher than the cumulative lifetime incidence of colorectal cancer. Little is known about the distribution of time from onset of adenoma to invasion in those adenomas that do progress. In a recent series of patients who developed carcinoma having previously had an untreated polyp, the cumulative risk of progression to cancer was 2.5% at 5 years, 8% at 10 years and 24% at 20 years (Stryker et al., 1987). Recent evidence on the molecular genetics of colorectal cancer also supports the adenomacarcinoma sequence, since mutation of the ras oncogene occurs in premalignant adenomas as well as colorectal carcinomas; it has been suggested that two later events in carcinogenesis, recessive changes on chromosomes 5 and 18, mark the transition from adenoma to carcinoma (Kerr, 1989).

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supporting

confidence: 48%

Is screening for colorectal cancer worthwhile?

Chamberlain

1990

Br J Cancer

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“…[14][15][16][17] However, those studies failed to show a consistent increase in participation, perhaps because advance notification letters were accompanied by educational material or the effect was masked by other barriers to participation associated with guaiac FOBTs. Using an advance notification letter with low information burden, coupled with removal of diet and medication barriers through the use of immunochemical tests, may allow the positive effect of advance notification to become evident.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] While most studies showed that this was associated with increased uptake, it was often administered together with educational materials and so the effect alone is unclear. Advance notification has never been trialled in programmes using faecal immunochemical tests (FIT) where several barriers to participation are reduced.…”

Section: Advance Notification Of Invitationmentioning

confidence: 99%

An advance notification letter increases participation in colorectal cancer screening

et al. 2007

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Objectives: To determine the impact of novel invitation strategies on population participation in faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening. Setting A community screening programme in Adelaide, South Australia. Methods: In total, 2400 people aged 50–74 years were randomly allocated to one of four CRC screening invitation strategies: (a) Control: standard invitation-to-screen letter explaining risk of CRC and the concept, value and method of screening; (b) Risk: invitation with additional messages related to CRC risk; (c) Advocacy: invitation with additional messages related to advocacy for screening from previous screening programme participants and (d) Advance Notification: first, a letter introducing Control letter messages followed by the standard invitation-to-screen. Invitations included an FIT kit. Programme participation rates were determined for each strategy relative to control. Associations between participation and sociodemographic variables were explored. Results: At 12 weeks after invitation, participation was: Control: 237/600 (39.5%); Risk: 242/600 (40.3%); Advocacy: 216/600 (36.0%) and Advance Notification: 290/600 (48.3%). Participation was significantly greater than Control only in the Advance Notification group (Relative risk [RR] 1.23, 95% confidence interval [CI] 1.06–1.43). This effect was apparent as early as two weeks from date of offer; Advance Notification: 151/600 (25.2%) versus Control: 109/600 (18.2%, RR 1.38, 95% CI 1.11–1.73). Conclusions: Advance notification significantly increased screening participation. The effect may be due to a population shift in readiness to undertake screening, and is consistent with the Transtheoretical Model of behaviour change. Risk or lay advocacy strategies did not improve screening participation. Organized screening programmes should consider using advance notification letters to improve programme participation.

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“…On one end of the spectrum, these features are externally imposed on participating organizations/subjects, such as providing physicians with fl ow sheets, 1,2 checklists, 3,4 or computer-based reminders, [5][6][7][8] or distributing patient educational materials. 6,9,10 Although such approaches can provide straightforward change mechanisms that ensure generalizability and treatment fi delity, they can pose problems when contextual variables contradict intervention fi delity 11 or when motivation to sustain changes wanes once the researchers leave. cesses for change emerge internally.…”

Section: Introductionmentioning

confidence: 99%

Effects of Facilitated Team Meetings and Learning Collaboratives on Colorectal Cancer Screening Rates in Primary Care Practices: A Cluster Randomized Trial

Shaw

Ohman‐Strickland

Piasecki

et al. 2013

The Annals of Family Medicine

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PURPOSE The purpose of this study was to evaluate a primary care practicebased quality improvement (QI) intervention aimed at improving colorectal cancer screening rates. METHODSThe Supporting Colorectal Cancer Outcomes through Participatory Enhancements (SCOPE) study was a cluster randomized trial of New Jersey primary care practices. On-site facilitation and learning collaboratives were used to engage multiple stakeholders throughout the change process to identify and implement strategies to enhance colorectal cancer screening. Practices were analyzed using quantitative (medical records, surveys) and qualitative data (observations, interviews, and audio recordings) at baseline and a 12-month follow-up. RESULTSComparing intervention and control arms of the 23 participating practices did not yield statistically signifi cant improvements in patients' colorectal cancer screening rates. Qualitative analyses provide insights into practices' QI implementation, including associations between how well leaders fostered team development and the extent to which team members felt psychologically safe. Successful QI implementation did not always translate into improved screening rates.CONCLUSIONS Although single-target, incremental QI interventions can be effective, practice transformation requires enhanced organizational learning and change capacities. The SCOPE model of QI may not be an optimal strategy if short-term guideline concordant numerical gains are the goal. Advancing the knowledge base of QI interventions requires future reports to address how and why QI interventions work rather than simply measuring whether they work.

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A comparison of methods for increasing compliance within a general practitioner based screening project for colorectal cancer and the effect on practitioner workload.

Abstract: Colorectal cancer is the second most common cause of death from malignant disease in England and Wales

Cited by 47 publications

References 15 publications

Is screening for colorectal cancer worthwhile?

Is screening for colorectal cancer worthwhile?

An advance notification letter increases participation in colorectal cancer screening

Effects of Facilitated Team Meetings and Learning Collaboratives on Colorectal Cancer Screening Rates in Primary Care Practices: A Cluster Randomized Trial

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