Increasing Uptake of Bowel Screening
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      Bowel cancer is the second biggest cancer killer in the UK, accounting for over 16,000 deaths
      per year. Screening can reduce deaths from bowel cancer if the people invited participate.
      The challenge is that high uptake of bowel screening is hard to achieve, and remains
      persistently below 65%.

      The faecal immunochemical test (FIT) is the most widely used bowel screening test worldwide.

      In the UK, FIT kits are mailed to people's homes without guidance on when the kit should be
      returned and only brief instruction on how to use it. Some people have said that even though
      they intend to complete and return the kit, they often forget or put off doing it.

      Two approaches are proposed to addressing this issue: i) providing a suggested deadline for
      FIT return, because it is known from breast and cervical cancer screening that giving people
      an appointment time increases uptake compared to an open invitation, and ii) planning sheets,
      that have been found to help people act on their intentions in other health contexts.

      This trial aims to evaluate the impact of providing a suggested deadline and a planning sheet
      on the return of FIT bowel screening kits.

      The trial is integrated within the Scottish Bowel Screening Programme. The investigators will
      randomly allocate 40,000 consecutive people that are due to be sent a FIT kit to one of eight
      groups:

      (i) control group (no deadline, no planning sheet), (ii) intervention group (1-week deadline,
      no planning sheet), (iii) intervention group (2-week deadline, no planning sheet), (iv)
      intervention group (4-week deadline, no planning sheet), (v) intervention group (no deadline,
      with planning sheet), (vi) intervention group (1-week deadline, with planning sheet), (vii)
      intervention group (2-week deadline, with planning sheet), (viii) intervention group (4-week
      deadline, with planning sheet).

      It will then be examined if having a suggested deadline and a planning sheet affects how many
      people send back their completed FIT kit. It will also be examined if the deadline length
      makes a difference and whether having both a deadline and a planning sheet affects the number
      of people returning their kit.

      Finally, the cognitive and behavioural mechanisms underlying any intervention effects will be
      assessed and the acceptability of the interventions explored, using questionnaires and
      in-depth interviews.
    


Intervention name(s): Suggested deadline for return of screening test; Planning sheet
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A screening invitation letter modified to state, highlighted in yellow: "Please return your kit within [X] weeks (by [DD.MM.YYYY]) or as soon as possible."; A planning tool presented on a separate single sheet of paper inserted into the screening invitation envelope. The colour illustrated tool prompts participants to identify concerns they have with using the bowel screening kit and to link them to a tip to help them overcome this concern.
Other intervention name(s): Volitional help sheet
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Early Detection of Cancer