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

Abstract

Background Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50–74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. Methods We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. Discussion This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001020976. Registered on 17 October 2020.

The implementation and mechanisms of advance notification for cancer screening: A scoping review

“…In fact, text message advance notifications delivered by general practitioners to encourage bowel cancer screening show promise for increasing participation in national programs. 62,63 In general, digital advance notifications, such as text messages and emails are highly efficient, convenient, and have widespread reach for promoting screening. While the effect of the four digital notifications captured in this review was mixed, 12,34,41,43 text message reminders (i.e., sent post-screening invitation) have been consistently shown to increase uptake of breast, bowel, and cervical screening, [64][65][66][67] suggesting that the use of electronic notifications may be a viable alternative to the dominant postal mail format.…”

“…For example, general practitioners are well placed to facilitate advance notification of cancer screening opportunities to their patients. In fact, text message advance notifications delivered by general practitioners to encourage bowel cancer screening show promise for increasing participation in national programs 62,63 . In general, digital advance notifications, such as text messages and emails are highly efficient, convenient, and have widespread reach for promoting screening.…”

Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.

“…A detailed trial protocol was published before practices were recruited, and the trial was conducted with no substantive changes to the protocol. 17 CONSORT guidelines 18 were used for reporting the trial.…”

“…Using existing evidence-based resources, along with an iterative process, the investigator team developed an SMS that included a text message with an embedded weblink, which opened to a customised webpage with four screens designed to increase screening. 17 Each weblink had a unique alphanumeric code to enable tracking of the number of times each webpage was opened. An SMS was sent from the person’s general practice to each eligible individual in the last week of the month before their kit was due.…”