Abstract
BackgroundThe NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a once-only flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded single-stage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England.Methods/designAll individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A’Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN.DiscussionThis feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences.Trial registrationInternational Standard Randomised Controlled Trial Number, ISRCTN13314752 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0093-8) contains supplementary material, which is available to authorized users.
Highlights
The National Health Service (NHS) Bowel Scope Screening (BSS) programme offers men and women aged 55 years a onceonly flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality
BSS offers the unique benefit of reducing CRC incidence as well as mortality, but this benefit can only be realised through uptake of the procedure
An additional limitation is that the patient navigation (PN) training session and related manual will be developed and delivered by non-PN experts, which may lower the extent to which Specialist Screening Practitioner (SSP) accept and identify with the PN intervention and their confidence to perform it. The results of this feasibility study will be instrumental in deciding whether a proposal will be made to conduct a large-scale randomised controlled trial (RCT) of the PN intervention in the BSS programme, in England
Summary
The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a onceonly flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. The benefits of BSS are contingent on uptake This National Institute for Health Research-funded singlestage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England. In England, the National Health Service (NHS) runs an organised population-based CRC screening programme (Bowel Cancer Screening Programme, BCSP) which offers biennial screening via guaiac-based faecal occult blood testing (gFOBt) to men and women aged 60–74. In March 2013, the BCSP started the national roll-out of the ‘Bowel Scope Screening (BSS) Programme,’ which offers men and women a single flexible sigmoidoscopy (FS) examination at age 55. BSS participation has been found to be strongly socially graded, ranging from 32.7 % in the most deprived to 53.2 % in the least deprived area quintiles, resulting in an urgent need to develop effective interventions to promote BSS uptake, among lower SES groups
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have