Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening

Raine, Rosalind; Duffy, SW; Wardle, Jane; Solmi, Francesca; Morris, Stephen; Howe, Rosemary; Kralj-Hans, Ines; Snowball, Julia; Counsell, Nicholas; Moss, Sue; Hackshaw, Allan; Wagner, Christian von; Vart, Gemma; McGregor, Lesley; Smith, Sally A.; Halloran, Stephen P; Handley, G; Logan, R. F. A.; Rainbow, S; Smith, Stephen C.; Thomas, MC; Atkin, Wendy

doi:10.1038/bjc.2015.413

Cited by 35 publications

(43 citation statements)

References 14 publications

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“…Intervention studies incorporating factors such as general practitioner (GP) endorsement,15 reminders and social networks have shown these can have a positive effect on uptake. However, the evidence is inconsistent,16 17 and effectiveness is likely to be, in part, influenced by the healthcare context in which the intervention is based.…”

Section: Introductionmentioning

confidence: 99%

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

et al. 2016

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ObjectiveOptimising uptake of colorectal cancer (CRC) screening is important to achieve projected health outcomes. Population-based screening by flexible sigmoidoscopy (FS) was introduced in England in 2013 (NHS Bowel scope screening). Little is known about reactions to the invitation to participate in FS screening, as offered within the context of the Bowel scope programme. We aimed to investigate responses to the screening invitation to inform understanding of decision-making, particularly in relation to non-participation in screening.DesignQualitative analysis of semistructured in-depth interviews and written accounts.Participants and settingPeople from 31 general practices in the North East and East of England invited to attend FS screening as part of NHS Bowel scope screening programme were sent invitations to take part in the study. We purposively sampled interviewees to ensure a range of accounts in terms of beliefs, screening attendance, sex and geographical location.Results20 screeners and 25 non-screeners were interviewed. Written responses describing reasons for, and circumstances surrounding, non-participation from a further 28 non-screeners were included in the analysis. Thematic analysis identified a range of reactions to the screening invitation, decision-making processes and barriers to participation. These include a perceived or actual lack of need; inability to attend; anxiety and fear about bowel preparation, procedures or hospital; inability or reluctance to self-administer an enema; beliefs about low susceptibility to bowel cancer or treatment and understanding of harm and benefits. The strength, rather than presence, of concerns about the test and perceived need for reassurance were important in the decision to participate for screeners and non-screeners. Decision-making occurs within the context of previous experiences and day-to-day life.ConclusionsUnderstanding the reasons for non-participation in FS screening can help inform strategies to improve uptake and may be transferable to other screening programmes.

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Section: Introductionmentioning

confidence: 99%

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

et al. 2016

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“…Another would see general practitioners performing the risk assessment, creating the opportunity to discuss and then manage modifiable risk factors. The latter approach may also result in greater uptake of the risk assessment and resulting screening recommendations, as demonstrated by studies involving general practitioner endorsement of iFOBT ( 51 , 52 ). Potential barriers to this option include upskilling the current workforce and integration into current general practitioner workflows ( 53 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program

Saya

Emery

Dowty

et al. 2020

JNCI Cancer Spectrum

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Background In many countries, population colorectal cancer (CRC) screening is based on age and family history, though more precise risk prediction could better target screening. We examined the impact of a CRC risk prediction model (incorporating age, sex, lifestyle, genomic and family history factors) to target screening under several feasible screening scenarios. Methods We estimated the model’s predicted CRC risk distribution in the Australian population. Predicted CRC risks were categorised into screening recommendations under three proposed scenarios to compare to current recommendations: a) highly tailored; b) three risk categories; c) four sex-specific risk categories. Under each scenario, for 35-74-year-olds, we calculated the number of CRC screens by immunochemical faecal occult blood testing (iFOBT) and colonoscopy, and the proportion of predicted CRCs over ten years in each screening group. Results Currently, 1.1% of 35-74-year-olds are recommended screening colonoscopy and 56.2% iFOBT. 5.7% and 83.2% of CRCs over ten years were predicted to occur in these groups respectively. For the scenarios: a) colonoscopy was recommended to 8.1% and iFOBT to 37.5%, with 36.1% and 50.1% of CRCs in each group; b) colonoscopy recommended to 2.4% and iFOBT to 56.0%, with 13.2% and 76.9% of cancers in each group; c) colonoscopy recommended to 5.0% and iFOBT to 54.2%, with 24.5% and 66.5% of cancers in each group. Conclusions A highly tailored CRC screening scenario results in many fewer screens but more cancers in those unscreened. Category-based scenarios may provide good balance between number of screens and cancers detected and be simpler to implement.

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“…Effective methods include, among others, sending advance notification letters [14,25] or reminder letters [26,27]. Furthermore, involvement of general practitioners or other trusted care providers in advocating CRC screening has a strong impact on utilization rates [28,29]. The latter provides a potential explanation for the gender gap observed among participants of the German CRC screening program, particularly regarding the use of gFOBT/FIT.…”

Section: Discussionmentioning

confidence: 99%

The effect of gender-specific invitation letters on utilization of colorectal cancer screening

et al. 2019

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Background and aim Colorectal cancer (CRC) screening can effectively reduce cancer-associated mortality. In Germany, individuals over the age of 50 or 55 have access to CRC screening services. However, utilization rates are persistently low, particular in the male population. This observational study investigates the effect of standard versus gender-specific invitation letters on utilization of CRC screening services. Methods We analyzed utilization rates of individuals who were insured by a large health insurance fund in Bavaria, Germany. Persons who became eligible for CRC screening received a standard (2013–2014) or a gender-specific invitation letter (2015–2016). We compared utilization rates within 6 months after receipt of the invitation letter using billing codes of the health insurance fund. Results Invitation letters were sent to 49 535 individuals, of which 48.8 % were gender-specific. The overall utilization rate did not differ between recipients of the standard versus gender-specific invitation letter (11.6 % vs 11.1 %; RR: 0.97 [0.92–1.02], p = 0.19). However, uptake of screening colonoscopy was significantly higher among recipients of gender-specific invitations (2.9 % vs 3.5 %; RR: 1.21 [1.04–1.39], p = 0.01), whereas utilization of fecal occult blood tests declined (10.4 % vs 9.7 %; RR: 0.93 [0.88–0.99], p = 0.016). Conclusions Gender-specific design of invitation letters can modify the patients’ preference for specific CRC screening services and increase the acceptance of screening colonoscopy.

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Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening

Cited by 35 publications

References 14 publications

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

Concerns, perceived need and competing priorities: a qualitative exploration of decision-making and non-participation in a population-based flexible sigmoidoscopy screening programme to prevent colorectal cancer

The Impact of a Comprehensive Risk Prediction Model for Colorectal Cancer on a Population Screening Program

The effect of gender-specific invitation letters on utilization of colorectal cancer screening

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