Individual invitation letters lead to significant increase in attendance for screening colonoscopies: Results of a pilot study in Northern Hesse, Germany

Stratmann, Katharina; Bock, Herbert; Filmann, Natalie; Fister, Petja; Weber, Christoph; Tacke, W; Simonis, B; Höftmann, M; Schröder, Oliver; Hausmann, Johannes; Zeuzem, Stefan; Blumenstein, Irina

doi:10.1177/2050640618769713

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…An important element of this reorganized CRC screening system are invitation letters. In fact, several pilot studies conducted in different German federal states demonstrated that the use of CRC screening services can be increased by personal invitation letters [16,17]. However, these and previous studies have demonstrated a major gender-specific difference in utilization of CRC screening in Germany, with significantly lower rates in males than females [11,17,18].…”

Section: Introductionmentioning

confidence: 94%

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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Section: Introductionmentioning

confidence: 94%

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

et al. 2019

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“…Substantial efforts have been made to increase screening participation. This includes pre-announcement letters, personal invitation that includes the FIT, and reminder letters for FIT testing or personal invitations for OC, all of which have led to a higher screening adherence 5 6 7 . Further increase in screening adherence could potentially reduce the incidence of and mortality from CRC 8 .…”

Section: Introductionmentioning

confidence: 99%

Second-generation colon capsule endoscopy for detection of colorectal polyps: Systematic review and meta-analysis of clinical trials

et al. 2021

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Background and study aims Adherence to colorectal cancer (CRC) screening is still unsatisfactory in many countries, thereby limiting prevention of CRC. Colon capsule endoscopy (CCE), a minimally invasive procedure, could be an alternative to fecal immunochemical tests or optical colonoscopy for CRC screening, and might increase adherence in CRC screening. This systematic review and meta-analysis evaluates the diagnostic accuracy of CCE compared to optical colonoscopy (OC) as the gold standard, adequacy of bowel preparation regimes and the patient perspective on diagnostic measures. Methods We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Register for Clinical Trials. Pooled estimates for sensitivity, specificity and the diagnostic odds ratio with their respective 95 % confidence intervals (CI) were calculated for studies providing sufficient data. Results Of 840 initially identified studies, 13 were included in the systematic review and up to 9 in the meta-analysis. The pooled sensitivities and specificities for polyps ≥ 6 mm were 87 % (95 % CI: 83 %–90 %) and 87 % (95 % CI: 76 %–93 %) in 8 studies, respectively. For polyps ≥ 10 mm, the pooled estimates for sensitivities and specificities were 87 % (95 % CI: 83 %–90 %) and 95 % (95 % CI: 92 %–97 %) in 9 studies, respectively. A patients’ perspective was assessed in 31 % (n = 4) of studies, and no preference of CCE over OC was reported. Bowel preparation was adequate in 61 % to 92 % of CCE exams. Conclusions CCE provides high diagnostic accuracy in an adequately cleaned large bowel. Conclusive findings on patient perspectives require further studies to increase acceptance/adherence of CCE for CRC screening.

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“…Efforts that involve direct patient contact, such as patient navigators or nurses with face-to-face counselling are the most effective [7]. This is also paramount for increasing adherence to colonoscopy screening programs [8].…”

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confidence: 99%

Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial

et al. 2020

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Background: Optimal patient education prior to colonoscopy improves adherence to instructions for bowel preparation and leads to cleaner colons. We developed computer based education (CBE) supported by video and 3D animations. We hypothesized that CBE replaces nurse counselling without losing quality of bowel preparation during colonoscopy. Methods: We conducted a prospective, multicenter, endoscopist blinded, non-inferiority randomized controlled trial. The primary outcome was adequate bowel preparation, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were sickness absence due to outpatient clinic visit, patient anxiety / satisfaction scores and information re-call. We included patients in four endoscopy units (rural, urban, and tertiary). Results: We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in per-protocol (PP) analysis, 217 in nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among groups. In PP analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse counselled patients (94%, 204/217), with a difference of -0.8% [95% CI [- 5.1; 3.5]%. Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse counselled patients (28.0% vs 4.8%). In CBE patients, 21.5% needed additional information, resulting in 3.0% extra outpatient visits. Conclusion: CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. CBE may serve as an efficient educational tool informing patients before colonoscopy in routine clinical practice.

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Individual invitation letters lead to significant increase in attendance for screening colonoscopies: Results of a pilot study in Northern Hesse, Germany

Abstract: Our study clearly indicates that personal invitation letters are an effective measure to increase overall participation rates in screening colonoscopies.

Cited by 7 publications

References 38 publications

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

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

Second-generation colon capsule endoscopy for detection of colorectal polyps: Systematic review and meta-analysis of clinical trials

Computer-based patient education is non-inferior to nurse counselling prior to colonoscopy: a multicenter randomized controlled trial

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