Anticipated regret to increase uptake of colorectal cancer screening (ARTICS): A randomised controlled trial

Abstract

Screening is important for early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase uptake of colorectal cancer screening. A randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters, was conducted. A total of 60,000 adults aged 50–74 years from the Scottish National Screening programme were randomised into the following groups: (1) no questionnaire (control), (2) Health Locus of Control questionnaire (HLOC) or (3) HLOC plus AR questionnaire. The primary outcome was return of the guaiac faecal occult blood test (FOBT). The secondary outcomes included intention to return test kit and perceived disgust (ICK). A total of 59,366 people were analysed as allocated (intention-to-treat (ITT)); no overall differences were seen between the treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). In total, 13,645 (34.2%) individuals returned the questionnaires. Analysis of the secondary questionnaire measures showed that AR indirectly affected FOBT uptake via intention, whilst ICK directly affected FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less-than-strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). The findings show that psychological concepts including AR and perceived disgust (ICK) are important factors in determining FOBT uptake. However, the AR intervention had no simple effect in the ITT analysis. It can be concluded that, in those with low intentions, exposure to AR may be required to increase FOBT uptake. The current controlled trials are presented at the website www.controlled-trials.com (number: ISRCTN74986452).

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

“…In total, 12,459 participants were allocated, 8571 through the in-practice recruitment method and 3888 through the fully automated recruitment method. The median age of participants was 45 (interquartile range [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] years, 33% were in the most deprived quintile of deprivation for England and 39% were of 'white' ethnicity, with no differences among trial arms.…”

“…This is one of the largest trials conducted using the QBE and the results add to the weight of evidence against a quantitatively important impact of an intervention based on the QBE. 50,51 A recent trial of the impact of the QBE on colorectal cancer screening uptake 46 also found no benefit of the intervention. Indeed, the effect of QBE interventions on uptake in our trial (OR 1.12/1.13) was highly consistent with the effect of the QBE on screening uptake reported in a recent review of the effects of the QBE on health behaviours 51 (d = 0.06 can be converted to an OR of 1.11 75 ).…”

“…Subsequent to the initiation of the present study, a further trial reported no significant QBE on the uptake of colorectal cancer screening via a FOBT in Scotland. 46 How does the question-behaviour effect work?…”

The question-behaviour effect: A theoretical and methodological review and meta-analysis

“…However, the reported effects have been mixed, with studies indicating that adding anticipated regret questions did (Sandberg & Conner, 2011) or did not (Godin et al, 2010;O'Carroll, Chambers, Brownlee, Libby, & Steele, 2015) increase the QBE. Wood et al (2016) reported that QBE studies that included anticipated regret items had a significantly smaller effect size than studies that did not include such items.…”

Anticipated regret and organ donor registration: A randomized controlled trial.

“…In this area of work, outcomes are also usually analysed for those who returned questionnaires 1 as this may reflect people who are also likely to be compliant to the target behaviour (e.g., O'Carroll, Chambers, Brownlee, Libby, & Steele, 2015). However, this does not take into account whether or not they have completed the key items (the active ingredients in these studies) in the questionnaire.…”