Patient level interventions—organised programmes
| Reference | Setting | Participants | Intervention vs control | Outcome | Participation |
|---|---|---|---|---|---|
| Senore et al87 | Population-based programmes Italy | Men and women aged 50–69 eligible for invitation in Italian FIT and FS programmes | Group A: standard personal invitation Group B: advance notification letter followed after 1 month by the standard personal invitation Group C: same as B+offer of GPs' consultation Reminder mailed to non-responders Predisposing–reinforcing factors | Participation rate following invitation and mail reminder | FIT programmes Group A: 44.9% (N=6596) Group B: 47.4% (N=6550) Group C: 46.1% (N=6572) RR B vs A: 1.06 (95% CI 1.02 to 1.10) RR C vs A: 1.03 (95% CI 0.99 to 1.07 FS programmes Group A: 26.0% (N=5220) Group B: 30.5% (N=5212) Group C: 31.0% (N=5223) RR B vs A: 1.17 (95% CI 1.10 to 1.25) RR C vs A: 1.19 (95% CI 1.12 to 1.27) |
| Libby et al88 | Population-based programme UK | Men and women aged 50–74 eligible for invitation in the Scottish gFOBT screening programme | Group A: standard personal invitation+gFOBT kit Group B: advance notification letter followed after 2 weeks by the standard personal invitation+gFOBT kit Group C: same as B+information booklet Reminder mailed to non-responders Predisposing factors | Participation rate following invitation and mail reminder | Group A: 53.5% (N=19 987) Group B: 59.0% (N=19 975) Group C: 58.5% (N=19 991) p<0.001 (C vs A and B vs A) |
| van Roon et al89 | Pilot population screening trial The Netherlands | General population sample of men and women aged 50–74 | Group A: advance notification letters followed after 2 weeks by the standard personal invitation Group B: standard personal invitation Reminder mailed to non-responders Predisposing factors | Participation rate following invitation and mail reminder | Group A: 64.4% (N=2493) Group B: 61.1% (N=2507) p=0.019 |
| Lo et al90 | London Hub, CRC screening programme UK | 23 182 individuals invited in their first screening round | Intervention: mailing of test kit and enhanced information leaflet (standard information+discussion of known barriers to screening) Predisposing factors Control mailing of test kit and standard information leaflet | Screening uptake rate | Control (N=10 768): 40.4% Intervention (n=12 414): 39.7% OR=0.97, 95% CI 0.91 to 1.04 |
| Denters et al91 | Second round of a biannual FIT-based CRC screening pilot The Netherlands | 10 265 individuals from the general population, aged 50–75 years | Intervention: invitation letter +information leaflet+test instructions+FIT kit+a faeces collection paper Enabling factors Control: invitation letter+information leaflet+test instructions+FIT kit | Participation in screening | Control: 52% (N=5136) Intervention: 52% (N=5129) RR: 0.99; 95% CI 0.97 to 1.04 |
| Hewitson et al92 | English Bowel Cancer Screening Programme UK | 1288 subjects registered with 20 GPs | Group 1=letter and leaflet Predisposing+reinforcing factors Group 2=GP letter onlyReinforcing factors Group 3=leaflet only Predisposing factors Group 4=usual care | Return of the test kit within 20 weeks | Group 1 (N=322) 61.2% (95% CI 56 to 67) Group 2 (N=322) 55.0% (95% CI 49 to 61) Group 3 (N=322) 55.3% (95% CI 50 to 61) Group 4 (N=322) 49.4% (95% CI 44 to 55) OR (95% CI)—per-protocol analysis Letter=1.17 (0.93 to 1.47) Leaflet=1.23 (0.98 to 1.56) GP signature=1.29 (1.01 to 1.63) Letter and leaflet=0.91 (0.58 to 1.44) |
| Cole et al93 | Community screening programme Australia | 2400 people aged 50–74 years listed in the electoral rolls | Control: standard invitation letter explaining CRC risk and rationale for screening Risk: standard invitation+additional messages focused on CRC risk Advocacy: standard invitation+additional advocacy messages from screening programme participants Advance notification: letter explaining CRC risk and rationale for screening followed by the standard invitation Predisposing factors Invitations included a FIT kit | Participation in screening, defined as the return of a completed sample card within 12 weeks from the date screening offers were posted | Control: 39.5% (237/600) Risk: 40.3% (242/600) Advocacy: 36.0% (216/600) Advance notification: 48.3% (290/600) RR (advance notification vs control): 1.23, 95% CI 1.06 to 1.43 |
| Wardle et al94 | Pilot screening trial UK | Subjects aged 55–64 invitation pilot FS screening trial | Group 1: mailed intervention brochure addressing barriers and benefits of FS screening Predisposing factors Group 2: standard invitation group | FS screening after intervention | Group 1 (N=1453): 53.5% Group 2 (N=1513): 19.9% χ2(1, N=2966)=3.94, p<0.05 |
| Cole et al95 | South Australian residents listed in two primary care practices and electoral rolls Australia | GP1, GP2 and GP3: person needed to have consulted with the GP in the previous 12 months and people of 50 and older years ER: older than 50 years | GP1: invitation letter not mentioning GPs' involvement GP2: invitation letter indicating GPs' involvement GP3: invitation letter with practice letterhead, signed by a practice partner Reinforcing factors ER: invitation letter not mentioning GPs' involvement A reminder was posted at 6 weeks | Participation defined as return of correctly completed FOBT sample cards within 12 weeks | GP1=32.0% (192/600) GP2=38.0% (228/600) GP3=40.7% (244/600) ER=32.2% (193/600) OR (GP2 vs GP1) 0.77, 95% (5% CI 0.60 to 0.98 OR (GP3 vs GP1) 0.69, 95% CI 0.54 to 0.87 |
| Gray et al96 | Pilot screening trial UK | Subjects aged 50–60 registered in a urban practice | Group 1: invitation+explanatory leaflet Group 2: invitation+explanatory leaflet+offer of prior consultation with GP | FS after intervention | Group 1 (N=165): 27% Group 2 (N=154): 21% |
| Hart et al97 | Pilot screening trial UK | Subjects aged 61–70 registered in a single general practice | Group 1: mailing of invitation letter+FOBT+prepaid return envelope+educational brochure Predisposing factors Group 2: mailing of invitation letter+FOBT kit+prepaid return envelope | FOBT completion after intervention | Group 1 (N=786) 36.2% (men aged 61–65) 39.0% (men aged 66–70) 37.8% (women aged 61–65) 30.5% (women aged 66–70) Group 2 (N=785) 26.8% (men aged 61–65) 23.5% (men aged 66–70) 36.0% (women aged 61–65) 30.6% (women aged 66–70) The booklet raised compliance among men in both age groups (p<0.05), but not among women |
CRC, colorectal cancer; FIT, faecal immunochemical test; FS, sigmoidoscopy; gFOBT, guaiac faecal occult blood test; GP, general practitioner.