Are Text Message Reminders an Effective Intervention for Improving the Uptake of Breast Screening?
Condition: Breast Screening
Study type: Interventional

Summary: 
      Breast Cancer is the single most common cancer, and the third leading cause of cancer cancer
      deaths, in the United Kingdom. Breast screening is able to detect breast cancer in the early
      stages of development, during which time it is more easily treatable. Unfortunately, many
      patients do not attend screening, and surveys issued to these women consistently report
      "forgetfulness" as the primary reason for missing the appointment. Both telephone reminders
      and postal reminders have been shown to reduce non-attendance, however, these are time
      consuming and expensive.

      Mobile telephones are becoming an increasingly popular tool for communication between
      healthcare professionals and patients, one which might offer an inexpensive solution for
      delivering reminders. Text message reminders have been able to prevent missed appointments in
      other areas of healthcare, and the same might be true for breast screening.

      The investigators are conducting a trial to confirm whether this is the case or not.

      In this trial, the investigators will send some women a text message to reminder them of
      their appointment, and other women no reminder for their appointment. The investigators will
      then compare the number of women in each group that went to their breast screening
      appointment.
    

Detailed description: 
      Breast cancer is the single most common cancer in the United Kingdom, accounting for 16% of
      all cancer incidences and 7% of all cancer deaths. Fortunately, the natural progression of
      this malignancy can be beneficially changed through mammographic screening techniques, which
      enable early detection and treatment of benign and malignant breast disease. However, the
      success of screening programmes depends not only on the analytical specificity and
      sensitivity of the screening test itself, but also its ability to attract the "at risk"
      population. In the United Kingdom, the National Health Service Breast Screening Programme
      attracts about three quarters of the invited population every three years. In the last
      screening round (2007-2010), all but one region reported a triennial coverage of more than
      75%; London was the exception, reporting a regional coverage of 69%. London consistently
      fails to meet the national target.

      Missed appointments are a primary cause of inefficiency in healthcare delivery, with adverse
      clinical implications for the non-attending patient, and substantial monetary costs to the
      health service. To ensure the future success of the breast screening programme it is
      imperative that strategies for improving uptake of hard to reach populations be developed.
      Research has demonstrated that receiving an appointment reminder by text message has been
      successful in improving uptake in other areas of healthcare; the same might be true for
      breast screening.

      Primary Aim: To establish whether text message reminders can significantly improve the uptake
      of breast screening by women on an "intention-to-treat" basis in the London Borough of
      Hillingdon.

      Secondary Aim: To evaluate whether text message reminders are an effective intervention for
      improving uptake of the breast screening programme by hard to reach patients such as women
      living in deprived areas, and those of Black and Minority ethnic backgrounds.

      Methodology: A single blind randomised controlled trial evaluating the effectiveness,
      efficacy, and acceptability of sending a text message appointment reminder to prevalent women
      (women aged 47-53 years) living in the London Borough of Hillingdon 48 hours prior to their
      first breast screening appointment. 2,239 women without a history of breast screening,
      implant, or bilateral mastectomy were included in the study and randomly assigned in a 1:1
      ratio to either the control group (n= 1,118) or the intervention group (n= 1,121). Women in
      the control group were invited to screening but received no reminder for their appointment,
      whilst women in the intervention group received a text message reminder 48 hours in advance.
      All women received an information letter about the study with their invitation from the West
      of London Breast Screening Service, which included a patient "opt-out" request form. Patients
      were not told whether they would be receiving a text message reminder or not. iPlato Patient
      Care Messaging was used to deliver the text-message reminders.
    

Intervention name(s): Text Message Reminder for Breast Screening Appointment
Intervention type(s): Other
Intervention description(s): Non-clinical/administrative.
Other intervention name(s): iPlato Patient Care Messaging will be used to send the text message reminder to the patient.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Text message reminders; Short Message Service (SMS) Reminders; Social Health Inequalities; Breast Screening; Screening; Public Health Intervention; Missed Appointments; Non-attendance