Introduction Uptake of bowel cancer screening in England is about 56%. The NHS Bowel Cancer Screening Programme (BCSP) in England is organised centrally, without the direct involvement of general practitioners (GPs). There is evidence to suggest that people are more likely to be screened if they are encouraged to do so by their GP.
The Practice Endorsed Additional Reminder Letter (PEARL) project is a collaboration between the BCSP Southern Hub and a group of Wessex GPs working for Macmillan Cancer Support in partnership with the Wessex Strategic Clinical Network.
Methods Wessex practices with BCSP uptake below 55% (prevalent episodes 2008–2013) were invited to participate. Between September 2014 and October 2015 subjects registered with participating practices who had not returned a test kit within 30 days of a standard reminder letter were identified on the BCSP database and their GPs asked to identify those who should not be sent a further reminder (end-of-life-care etc). The Hub then confirmed that GP-included subjects remained non-respondent and a second reminder letter was sent out with the appropriate GP letterhead and signature.
Uptake was compared between PEARL and non-PEARL practices using logistic regression, adjusted for prior prevalent participation and using conservative variance estimation to take account of correlation of outcomes within practices. To estimate the absolute effect of the intervention, we selected 25 non-PEARL practices matched with PEARL practices for prior prevalent participation and number of invitees.
Results The intervention significantly increased the odds of uptake by 12% (OR = 1.12, 95% CI 1.04–1.19, p = 0.001). Restricting analysis to subjects who had not completed a kit by the index date (date PEARL reminder letter was sent, or would have been sent if in a participating practice), also showed a significant effect of the intervention (2.13 [1.78–2.56]).
Conclusion The PEARL intervention increased uptake by about 4 percentage points, both as a proportion of all invitees or only those who had not completed a kit by the index date. The extra work PEARL required will be evaluated and recommendations made on the viability of rolling this process out nationally within the BCSP.
Disclosure of Interest None Declared
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