Title: Increasing uptake of faecal immunochemical test (FIT) bowel screening: trial of providing a suggested deadline for FIT kit return
Funder: Cancer Research UK

Abstract: Background Bowel cancer is the second most common cause of cancer death in the UK. Screening can reduce deaths from bowel cancer if the people invited participate, but uptake remains low. The introduction of the new bowel screening test (faecal immunochemical test: FIT) provides a timely opportunity to optimise uptake to improve earlier diagnosis of bowel cancer in the UK. The proposed research builds on our previous National Awareness and Early Diagnosis Initiative grant findings. Evidence shows that people are willing to participate in cancer screening but often put it off or forget. Currently, bowel screening kits are mailed as an open invitation with no guidance on when the kit should be returned. Analysis of interviews in our study suggested providing a deadline for bowel screening kit return may prompt more people to participate. Aims Our aim is to test the impact of providing a suggested deadline for FIT kit return on uptake of FIT bowel screening. Methods In Study 1, we will randomised 40,000 consecutive adults (50-74 years) from the Scottish Bowel Screening Programme to receive one of four invitation letters including a suggested deadline of: i) 1-week; ii) 2-weeks; iii) 4-weeks; and iv) no suggested deadline, standard invitation letter. The primary outcome measure will be return of the FIT kit. In Study 2, we will quantitatively assess the acceptability, and cognitive and behavioural mechanisms underlying any impact of providing a suggested deadline for FIT kit return by mailing a questionnaire to a subsample of participants from Study 1 who did and did not complete the FIT kit. In Study 3, we will qualitatively analyse the acceptability, and the cognitive and behavioural mechanisms underlying any impact of providing a suggested deadline for FIT kit return using interviews, with a purposive sample of people identified through the Study 2 dataset. How the results of this research will be used Providing a suggested deadline for FIT kit return is a low cost intervention that can be implemented rapidly and at scale. If the results are positive, a simple change to the wording of the bowel screening programmes’ invitation letters will be all that is required to immediately see the benefits of increased uptake and subsequent earlier diagnosis of bowel cancer in the UK.

Lay abstract: Background Bowel cancer is the second most common cause of cancer death in the UK. Screening can reduce deaths from bowel cancer if the people invited participate, but uptake remains low. The introduction of the new bowel screening test (faecal immunochemical test: FIT) provides a timely opportunity to optimise uptake to improve earlier diagnosis of bowel cancer in the UK. The proposed research builds on our previous National Awareness and Early Diagnosis Initiative grant findings. Evidence shows that people are willing to participate in cancer screening but often put it off or forget. Currently, bowel screening kits are mailed as an open invitation with no guidance on when the kit should be returned. Analysis of interviews in our study suggested providing a deadline for bowel screening kit return may prompt more people to participate. Aims Our aim is to test the impact of providing a suggested deadline for FIT kit return on uptake of FIT bowel screening. Methods In Study 1, we will randomised 40,000 consecutive adults (50-74 years) from the Scottish Bowel Screening Programme to receive one of four invitation letters including a suggested deadline of: i) 1-week; ii) 2-weeks; iii) 4-weeks; and iv) no suggested deadline, standard invitation letter. The primary outcome measure will be return of the FIT kit. In Study 2, we will quantitatively assess the acceptability, and cognitive and behavioural mechanisms underlying any impact of providing a suggested deadline for FIT kit return by mailing a questionnaire to a subsample of participants from Study 1 who did and did not complete the FIT kit. In Study 3, we will qualitatively analyse the acceptability, and the cognitive and behavioural mechanisms underlying any impact of providing a suggested deadline for FIT kit return using interviews, with a purposive sample of people identified through the Study 2 dataset. How the results of this research will be used Providing a suggested deadline for FIT kit return is a low cost intervention that can be implemented rapidly and at scale. If the results are positive, a simple change to the wording of the bowel screening programmes’ invitation letters will be all that is required to immediately see the benefits of increased uptake and subsequent earlier diagnosis of bowel cancer in the UK.

Research activity codes: 4.3 INFLUENCES AND IMPACT
Health categories: CANCER AND NEOPLASMS