Abstract
BackgroundIncreasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50–74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice.MethodsWe will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit.DiscussionThis efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620001020976. Registered on 17 October 2020.
Highlights
Background and rationale {6a} Australia and New Zealand have some of the highest rates of colorectal cancer (CRC) in the world [1]
Study setting {9} The SMARTscreen trial will be conducted in general practices located in the Western Victorian Primary Health Network (WVPHN) [21] catchment in Victoria, Australia, which includes a mix of regional cities and towns, and socio-economic and demographic diversity
Eligibility criteria {10} Inclusion criteria for general practices General practices will be eligible to participate in the SMARTscreen trial if they are located in the WVPHN region, their electronic medical record (EMR) system is compatible with the Pen CS Clinical Audit Tool 4 (CAT4) clinical audit tool software (CAT: Pen Computer Systems; Leichardt, NSW, Australia) [24] and the short messaging service (SMS) recall platform called Go Share Plus [25] developed by Healthily
Summary
Background and rationale {6a} Australia and New Zealand have some of the highest rates of colorectal cancer (CRC) in the world [1]. The simplest and most cost-effective method for reducing mortality from CRC is to detect precancerous or early disease through screening with a self-collected immunochemical faecal occult blood test (‘FOBT’) [3]. The Australian Government implemented a National Bowel Cancer Screening Program (NBCSP), sending people aged between 50 and 74 years a free home-based FOBT test kit every 2 years [4]. Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Only 44% of Australians aged 50–74 years complete the NBCSP This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. A process evaluation will explore the barriers and facilitators to sending the SMS from general practice
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