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NHS bowel screening uptake boosted by ‘reassuring reminders’

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Bowel scope screening uptake can increase by more than a fifth when patients are sent two additional reminders with a leaflet that addressed common concerns, according to a new study.

The study, involving 1,218 patients and funded by Cancer Research UK, found screening uptake went up by 21.5% when a “theory-based leaflet” was used as well as two follow-up reminders.

“Providing information targeting the concerns of patients is one way to break down the barriers to screening uptake”

Robert Kerrison

The NHS bowel scope screening programme is gradually being rolled out in England to men and women aged between 55 and 59, prior to the bowel screening programme offered at 60.

Usually an invitation with a standard information booklet and an appointment time is sent to people on reaching the age of 55. It is then up to the recipient to confirm and attend their appointment.

The one-off, preventative and diagnostic test involves a flexible sigmoidoscope being inserted into the bowel to find and remove any polyps, which could eventually turn into cancer.

However, despite being offered automatically and for free, the uptake of bowel scope screening is both low and socioeconomically graded, noted the researchers.

A previous study found only 43% of men and women invited for scope screening attended an appointment, and uptake was worst in deprived areas. The researchers highlighted that the main concerns about the test had been found to include embarrassment, pain and fear of harm to the bowel.

The new study, carried out in Brent and Harrow in London, set out to examine whether a first and second self-referral reminder increased the uptake of screening among former non-participants and to test a “theory-based leaflet”.

“Studies such as this help us learn about the best way to provide information in a way that resonates with people”

Jodie Moffat

The leaflet, created by the researchers from University College London with help from the public, included patient testimonials and advice from a named and pictured local GP to address this.

The reminder letters, sent one and two years after the initial invitation, allowed patients to choose the time of their appointment and the gender of the doctor performing the test.

Additional uptake following the second reminder alone was 0.4%. But it was 4.8%, and 7.9% a reminder and standard information booklet or reminder and theory-based leaflet, respectively.

When combined with the impact of the first reminder, the overall uptake for each group after the second reminder was 0.7%, 14.5%, and 21.5%, said the researchers.

“Sending former non-participants a self-referral reminder 12 and 24 months after their initial invitation was effective at improving uptake and was enhanced by the inclusion of a theory-based leaflet,” they said in the journal Annals of Behavioural Medicine.

Dr Robert Kerrison, lead researcher from University College London, said: “Despite bowel scope screening attendance being low where it has been rolled out so far, this research shows that more could be done to improve uptake.

“Providing information targeting the concerns of patients is one way to break down the barriers to bowel scope screening uptake,” he said.

Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis, said: “Cancer screening offers a lot of potential for reducing the burden of cancer but there are harms as well as benefits, so it’s important that people make their own decision about whether to take part or not.

“Studies such as this help us learn about the best way to provide information in a way that resonates with people and ensures we can minimise any unnecessary barriers to people taking part,” she said.

“To fully realise the potential of cancer screening we need a system that adopts research findings into practice and has enough of the right workforce to deliver what’s needed,” she added.

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