Testing the effectiveness of a general practice intervention to improve uptake of colorectal cancer screening: a randomised controlled trial

Abstract

Objective: Uptake of screening through the Australian National Bowel Cancer Screening Program remains low. General practice guidelines support the general practitioners’ role to offer CRC screening. This study tests the effect that an intervention including point‐of‐care FOBT provision, printed screening advice and GP endorsement has on self‐reported FOBT uptake. Methods: A multisite, 1:1 parallel‐arm, cluster‐randomised controlled trial. Participants aged 50–74, at average risk of CRC and overdue for screening were recruited from four general practices in New South Wales, Australia, from September 2016 to May 2017. Self‐report of FOBT up to eight weeks post baseline. Results: A total of 336 participants consented to complete a baseline survey (64% consent rate), of which 123 were recruited into the trial (28 usual care days and 26 intervention days). Follow‐up data was collected for 114 participants (65 usual care and 49 intervention). Those receiving the intervention had ten times greater odds of completing screening compared to usual care (39% vs. 6%; OR 10.24; 95%CI 2.9‐36.6, p=0.0006). Conclusions: A multicomponent intervention delivered in general practice significantly increased self‐reported FOBT uptake in those at average risk of CRC. Implications for public health: General practice interventions could serve as an important adjunct to the Australian National Bowel Cancer Screening Program to boost plateauing screening rates.

From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program

“…Nineteen eligible studies included professional-level interventions to improve adherence to CRC screening programs, although most (n ¼ 15) simultaneously included patient-or system-level interventions as a multi-component study. In a comparable way to studies that test the effectiveness of patient reminders for screening, point-of-care prompts to the physician (at the time of the patient consultation) also tended to demonstrate improvements in adherence to CRC screening in primary care (Sequist et al 2009;Aragones et al 2010;Fiscella et al 2011;Hendren et al 2014;Guiriguet et al 2016;Dodd et al 2019). Training initiatives targeting professionals reported mixed results (such as training in specific tools or conditions; Fiscella et al 2011;Maddocks et al 2011;Basch et al 2015;Sun et al 2018) and training in communication skills, cultural competency, patient involvement, support to self-manage etc.…”

“…In summary, our review points to a potential opportunity to enhance the PHC role to maximise the benefits of populationbased bowel cancer screening programs through existing primary care preventive and QI initiatives. As noted by Dodd et al (2019), the possibility exists for PHC in Australia to adopt an important 'adjunct' role to support the NBCSP along the entire screening pathway, particularly for those asymptomatic, eligible patients who are more difficult to reach. The NBCSP cost-effectiveness warrants the investment in evidence-based strategies to improve screening adherence, particularly those that target improved CRC screening and follow up in primary care services (Worthington et al 2020).…”

“…Reminders for screening (Walsh et al 2005;Myers et al 2007;Fiscella et al 2011;Dietrich et al 2013;Green et al 2013;Leone et al 2013;Baker et al 2014;Cohen-Cline et al 2014;Hendren et al 2014;Phillips et al 2015;Benton et al 2017; GP-Program interaction: systems initiated by an organised screening program to support GPs in monitoring/processes of care. Hirst et al 2017;Kiran et al 2018;Sun et al 2018;Dodd et al 2019; using different formats, e.g. text messaging (Hirst et al 2017), GP-endorsed mail-outs (Benton et al 2017;Kiran et al 2018) and automated telephone calls (Phillips et al 2015), or a combination) were also mostly effective in improving adherence in organised CRC screening programs for both eligible patients not up-to-date with screening and under-screened population subgroups.…”

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

“…A recent systematic review and meta-analysis found that combining multiple evidence-based interventions that address known barriers are more effective in increasing CRC screening uptake than using single strategies alone [ 20 ]. Qualitative studies highlight a need for accessible information about bowel cancer in a visual format and simplified diagrammatic steps for doing the test along with GP endorsement [ 39 , 40 ]. The challenge is to determine the selection of, and the ideal format for the delivery of these interventions to people eligible to participate in CRC screening.…”

Factors Associated with Participation in Stool Based Colorectal Screening in Brunei Darussalam

“…Additional measures such as reminder (i.e. telephone follow up reminder), primary care physicians' participations (Dodd et al, 2019), better coverage and public education have been shown to improve participation rates.…”