Extract

Background & aims: Bowel cancer is the fourth most common cancer in England, and the second leading cause of cancer deaths. Detecting the disease early is associated with improved chances for survival; however, most cases are diagnosed late as most patients don't tend to develop symptoms in the early stages. Screening helps to detect cases early, by testing for the disease before any symptoms occur. In England, there is a national bowel cancer screening programme where men and women are invited for a 'one-off' test, called a flexible sigmoidoscopy (or 'bowel scope'), shortly after their 55th birthday. This test is able to save lives from bowel cancer not only by detecting cases early, by preventing them through the timely removal of growths which pre-cancerous (these are commonly referred to as polyps or 'adenomas'). However, less than half of all people (around 40%) attend their screening appointment when invited by the NHS, and this limits the number cancers the programme is able to detect/prevent. There are a number of reasons why people do not screening appointments, such as forgetting to go, being worried that the screening test might be embarrassing or painful and not being unavailable to attend at that time. Anyone who does not attend their appointment can re-book up until the age of 60, but is otherwise not re-invited to participate (people only ever receive one invitation, it is then up to them to contact the screening centre if they want to arrange an appointment). The aim of this study was to examine whether mailed reminders, prompting non-participants to self-refer for screening one & two years after their invitation, could increase screening rates, and whether these 'annual reminders' are more effective when combined with locally tailored information leaflets that have been designed to address patient-related factors for non-attendance (such as worry about the test being painful or embarrassing). Who can participate? Adults aged 55-59 registered with a GP Practice in the London Boroughs of Brent and Harrow. What does the study involve? In this study, participants are randomly assigned to one of three groups: a 'control group', in which participants do not receive a reminder prompting them to book an appointment; a reminder plus 'standard leaflet' group, in which participants receive a reminder and standard information leaflet one and (if they still have not booked an appointment) two years after their initial invitation; and a reminder plus locally tailored information leaflet group, in which participants receive a reminder and locally tailored information leaflet designed to address common reasons for non-participation one and (if they still have not booked an appointment) two years after their initial appointment. In addition, participants who attend an appointment are asked to complete a questionnaire about why they did not attend previously and why they decided to make attend an appointment at this time. What are the possible benefits and risks of participating? Participants aren't able to enrol in the study, they will be randomly selected from a list of screening eligible 'non-participants'. Participants who made a misinformed (i.e. did not understand the purpose of the screening test) or non-deliberate (i.e. forgot to go to their appointment) decision to not participate in screening previously will benefit from a second opportunity to participate, have their concerns about screening addressed and their risk of getting/dying from bowel cancer being reduced. There are risks associate with flexible sigmoidoscopy screening, including bowel perforation (1 in 3,000), which results in serious bleeding. Where is the study run from? St. Marks' Hospital, London (UK) When is study starting and how long is it expected to run for? March 2015 to September 2016 How long will the trial be recruiting participants for? St. Marks' Hospital, London (UK) Who is the main contact? Sarah Marshall [email protected]

Inclusion criteria

• We are investigating whether a mailed reminder, with instructions on how to book an appointment, can facilitate uptake of flexible sigmoidoscopy (bowel scope) screening in previous non-participants

Links

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