Participation In Bowel Cancer Screening Research Articles

Spatial variability in socio-demographic factors affecting participation in the Australian national bowel cancer screening program

ObjectivesThe objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs. Study designThis is a nationwide ecological study based on aggregate spatial data. MethodsAn ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis. ResultsThe global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability. ConclusionFrom a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.

Geographical and spatial variations in bowel cancer screening participation, Australia, 2015-2020.

Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015-2020. Publicly available population-level participation data for Australia's National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019-2020 compared to the national average, and during 2015-2016 and 2017-2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test. Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019-2020. Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.

Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study.

The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry. We predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.

Psychological distress and bowel cancer screening participation.

To better understand barriers to participation in mail-out bowel cancer screening programs, two survey studies tested the relationship between psychological distress and self-reported bowel cancer screening. First, a nationally representative sample of Australians N=5421 completed measures of bowel cancer screening and psychological distress (using the Kessler Psychological Distress Scale; K10). Second, N=479 completed a survey measuring participation in the National Bowel Cancer Screening Program (NBCSP) and psychological distress using the Depression, Anxiety and Stress Scale. In both studies, logistic regressions were conducted to test relationships between psychological distress and self-reported screening participation. Study one found that psychological distress had a significant quadratic effect on having ever screened for bowel cancer, where screening rates were similar for those with low, moderate, or high levels of distress, but were lower for those with very high levels of distress. In study two, depression scores had a negative linear relationship with NBCSP participation (higher depression levels were associated with lower screening participation), and anxiety had a quadratic effect whereby NBCSP participation rates were higher with increasing levels of anxiety except in the severe category, where participation was significantly lower. Findings indicate that psychological distress has a complex relationship with screening, and those with extreme levels of distress consistently show lower participation rates. Special efforts to encourage screening may be required for those experiencing extreme psychological distress and mental health disorders.

Strategies to address barriers and improve bowel cancer screening participation in Indigenous populations, particularly in rural and remote communities: A scoping review.

Participation in bowel cancer screening programs is low in Indigenous1 Australian populations, particularly in rural and remote communities. There is growing evidence of strategies to increase screening rates amongst Indigenous Australians, however, there are limited strategies specific to rural and remote communities. This review aims to identify strategies that may increase bowel cancer screening rates amongst Indigenous populations, particularly in rural and remote communities. A literature search was undertaken which included peer-reviewed qualitative and quantitative articles of any study design, and grey literature. Evidence from New Zealand, Canada, United Kingdom, and Australia were included, and descriptive numerical and thematic analyses were conducted. The identified strategies were categorised using the National Cancer Policy Board's organisational framework. Nineteen strategies were identified from 23 included articles. The most frequently used strategies were recommendation from a general practitioner, culturally appropriate education resources, and nonresponder follow up. Four strategies were specific to rural and remote communities including alternative distribution of kits and mobile screening. Thirteen strategies aim to address the Knowledge category of the framework, four address Attitudes, four address Ability, and six address Reinforcement. So What?: Several strategies are available to increase bowel cancer screening in Indigenous populations, with very few strategies specifically relating to rural and remote communities. Multiple strategies may maximise the likelihood of participation in screening amongst Indigenous Australians. Implementation may require system-level and local-level changes.

The role of need for control and self-reliance in gender and age differences in bowel cancer screening participation.

To examine the relationships between need for control and self-reliance and barriers to bowel cancer screening to better understand the reasons for lower bowel cancer screening adherence in males and younger individuals. Participants (n=506) aged between 54 and 75years old completed an online survey measuring demographic information, the four-factor Barriers to Home Bowel Cancer Screening Scale (BB-CanS) and a measure of Need for Control and Self-Reliance (NCSR). Model fit statistics were compared for seven path models testing the relationships between NCSR and BB-CanS factors and the moderating and mediating effects of age and gender. Models where age and gender were included as moderators showed the best fit. When compared to females and those under 60years of age, stronger positive associations between NCSR and BB-CanS factors were evident among males (βavoidance =0.539, p<0.001); βdisgust =0.558, p<0.001; βdifficulty =0.489, p<0.001; βautonomy =0.619, p=0.002) and those over 60years of age (βavoidance =0.400, p<0.001); βdisgust =0.462, p<0.001; βdifficulty =0.447, p<0.001; βautonomy =0.378, p<0.001. When encouraging males and people aged 60years and over to participate in bowel cancer screening, public health messages may benefit from conveying preventative health behaviour and cancer screening participation as actions that reflect self-control and self-reliance.

Identifying modifiable features of home bowel cancer screening kits to facilitate use: consumer perspectives.

Despite the widely publicised health benefits of participation in bowel cancer screening, only 43.5% of recipients participate in the Australian National Bowel Cancer Screening Program (NBCSP). Through consultation with kit recipients, this study aimed to identify features of home bowel screening kits that could be modified to increase their use. Participants (n = 25) were presented with nine different bowel cancer screening kits and asked to identify features of each kit that might prevent or promote their use. Responses were coded using content analysis, and a narrative synthesis is presented summarising preferences relating to each element of the kit. Six modifiable elements were identified: collection tool, collection sheet, specimen container, instruction, packaging and processes. Participant preferences were for collection devices that limited the users' proximity to faecal matter, smaller packaging, simpler processes and step-by-step pictorial instructions. Responses regarding aesthetics, the amount of information included and receiving immediate results were mixed. Findings provide several consumer-driven recommendations, which are to be tested in future research aimed at improving the acceptability and usability of kits distributed in population bowel cancer screening programs.

What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

BackgroundColorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation.MethodsWe searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening.ResultsNational programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features.ConclusionsApart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation.ImpactThis screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.

"Whilst you are here…" Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme.

ObjectivesThis research aimed to assess women's willingness to receive advice about cervical and bowel cancer screening participation and advice on cancer symptom awareness when attending breast cancer screening.MethodsWomen (n = 322) aged 60–64 years, living in the United Kingdom, who had previously taken part in breast cancer screening were recruited via a market research panel. They completed an online survey assessing willingness to receive advice, the potential impact of advice on breast screening participation, prospective acceptability and preferences for mode and timing of advice.ResultsMost women would be willing to receive information about cervical (86%) and bowel cancer screening (90%) and early symptoms of other cancers (92%) at a breast cancer screening appointment. Those who were not up to date with cervical cancer screening were less willing. Prospective acceptability was high for all three forms of advice and was associated with willingness to receive advice. Women would prefer to receive advice through a leaflet (41%) or discussion with the mammographer (30%) either before the appointment (27%), at the appointment (44%) or with their results (22%).ConclusionsWhile there is high willingness and high acceptability towards using breast cancer screening as a teachable moment for advice about prevention and early detection of other cancers, some women find it unacceptable and this may reduce their likelihood of attending a breast screening appointment.Patient or Public ContributionThis study focused on gaining women's insights into potential future initiatives to encourage screening and early diagnosis of cancer. Members of the public were also involved in piloting the questionnaire.

Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial

To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme. The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation. Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result. General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.

Impact of a mass media campaign on participation in the Australian bowel cancer screening program

To examine the effect of a mass media campaign designed to increase bowel cancer screening participation. We assessed weekly participation, from January 2015 to December 2017, in the Australian National Bowel Cancer Screening Program in Victoria, where a seven-week campaign aired in mid-2017, and in the adjacent comparison state of South Australia. Participation, defined as the number of immunochemical faecal occult blood tests returned out of those invited by the Screening Program in the past 16 weeks, was analysed using negative binomial regression. Compared with non-campaign weeks, there was an increase in the return rate in the campaign state during campaign weeks (adjusted return rates non-campaign weeks = 34.4% vs. campaign weeks = 45.3%, p < 0.01), not observed in the comparison state (38.3% vs. 40.3%, p > 0.05). The increase in the return rate was significantly greater in the campaign state (Rate Ratio of Campaign/Non-Campaign weeks = 1.31, p < 0.01) than the comparison state (1.05, p > 0.05, interaction p < 0.001), and did not differ significantly by age, sex or socio-economic area. The relative increase was greater among never-participants (Rate Ratio of Campaign/Non-Campaign weeks = 1.24) than previous-participants (1.16), interaction p < 0.001). This mass media campaign increased bowel cancer screening participation, including from never and low participation subgroups. To maximize participation and ensure equitable population benefit, repeated campaigns that reach eligible people about bowel cancer risks and potential life-saving benefits of screening should be standard.

Increasing bowel cancer screening participation: integrating population-wide, primary care and more targeted approaches.

Participation in the Australian National Bowel Cancer Screening Program (NBCSP) is suboptimal. Given the program's enormous potential to save lives, Cancer Council Victoria has prioritised increased screening participation as part of its strategic plan. This paper describes the implementation, and evaluation where available, of Cancer Council Victoria programs to increase participation, supported by a mix of own organisation and Victorian state health department funding. Type of programs: At the population level, Cancer Council Victoria has delivered television-led mass media campaigns to motivate age-eligible individuals to complete and return their NBCSP kit. It has also delivered targeted awareness and education programs for underscreened populations including Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse communities, and groups experiencing social disadvantage. Programs involving general practice have also been trialled to improve the knowledge and confidence of general practitioners (GPs) to discuss bowel screening with their patients, and to implement identification, reminder and follow-up systems to improve bowel screening participation. There is strong evidence to support the use of mass media public health campaigns, which have resulted in significant increases in screening kit return rates. Targeted education sessions with underscreened communities have led to increases in knowledge about bowel cancer screening, confidence to do the test and intention to participate in the NBCSP in communities where these sessions have been trialled. Early findings suggest that GP endorsement strategies are welcomed by patients and are an effective way to encourage NBCSP participation. System changes using patient information systems may be more challenging, given the inconsistent entry of NBCSP data. Our work to date demonstrates that there is a strong case for regular, widespread mass media strategies to increase NBCSP participation. There is also evidence to support more tailored, complementary approaches with dedicated education programs for underscreened groups, and active and sustained engagement with underscreened communities and primary care providers to overcome personal, cultural and systems barriers to screening. Improved data capture capabilities are needed to better implement and evaluate the impact of future strategies to improve NBCSP participation.

Impact of a mass media campaign on participation rates in a National Bowel Cancer Screening Program: a field experiment

Objectives and designThis field experiment aimed to compare bowel cancer screening participation rates prior to, during and after a mass media campaign promoting screening, and the extent to which a...

Bowel Cancer Screening Participation in Rural Tasmania: A Comparative Case Study of Four Local Government Areas

Background: Bowel cancer is a preventable condition, yet it is the second most common cancer after prostate cancer, with one in 12 Australians developing the disease by age 85. If detected early, the chances of survival are very high. One way to detect bowel cancer before it becomes a problem is through the use of a screening kit. The Australian government has distributed free kits to specific age groups since 2006, through their National Bowel Cancer Screening Program (NBCSP). Participation in the NBCSP is currently quite low (39% Australia-wide). In Tasmania, participation rates among local government areas (LGAs) range from 28% to 47%. These differences in participation are especially apparent in rural and remote areas and form the focus of this research. Aim: Our research aims to determine why there are marked differences in National Bowel Cancer Screening Program participation rates between rural LGAs in Tasmania. Secondary aims include developing future strategies for increased screening uptake in rural Tasmania. Method: A total of four LGAs, identified as having either high (n=2) or low (n=2) NBCSP participation rates, were included in the study. Face to face interviews with community members and stakeholders across the four LGAs were recorded and transcribed to obtain qualitative data. A total of 50 male and female community members aged 50-75 were recruited and interviewed regardless of whether they had used the NBCSP kit. A total of 28 health professionals including doctors, pharmacists, nurses and health promotion officers, working in each of the four LGAs were also interviewed. All interviews were recorded and transcribed. Thematic analysis was conducted to elucidate common barriers and enablers for screening, as well as suggestions for increasing NBCSP participation rates in Tasmania. Demographic data including age, gender, and educational attainment were collected from community members to further identify potential associations with screening participation. Results: All interviews have been successfully completed and transcribed, and thematic analysis has begun. Themes emerging from the data to date include the importance of community connectedness; the role of women in encouraging men to screen; health literacy; new/transient versus established/stable communities; and access to follow-up colonoscopies. Final results will be available shortly and presented in full. Conclusion: The findings from this study will highlight differences and reasons for screening participation in four rural Tasmanian LGAs. The results will have implications for the NBCSP in terms of recommendations for increasing participation in the program.

Using Clinical Prompts in General Practice to Increase Participation in the National Bowel Cancer Screening Program: A Case Study Protocol

Background: One in 12 Australians is expected to develop bowel cancer by age 85. Over 90% of bowel cancers can be successfully treated if detected early yet participation rates in the National Bowel Cancer Screening Program (NBCSP) are currently only 39%. Research shows that general practitioner (GP) recommendation is a key predictor for bowel cancer screening uptake. However the current NBCSP invitation system does not involve GPs, making it difficult for them to know when a patient has received a test kit in the mail, and in turn play a role in screening behavior. Research suggests that GP point-of-care clinical prompts, encouraging GPs to discuss screening with their patients, can increase fecal occult blood testing. Such a ´reminder´ system is integral to other screening programs in Australia, however no such system exists for the NBCSP. The George Town Medical Centre located in rural Tasmania, has recently implemented a reminder prompt for bowel cancer screening as part of its standard clinical practice. This paper describes the protocol used to implement and evaluate this service. Aim: Our research aims to determine whether a clinical prompt delivered to GPs at point-of-care, can increase bowel cancer screening participation in patients attending a rural Tasmanian general practice. Secondary aims include assessing GP and patient attitudes toward the prompt and determining socio-demographic differences in the effect of the prompt on screening participation. Methods: The clinical prompt was implemented in January 2018. Active patients turning 50 (n=106), 60 (n=141) or 70 (n=103) in 2018 were eligible to receive the prompt. The prompt was created within the practice management software and associated with each eligible patient's file. GPs were provided with information on the NBCSP as well as resources to support their conversation with patients including a sample kit. The number of patients with whom the GP discussed screening and the number of patients who completed a kit will be collected after 12 months. Screening rates of patients eligible for the prompt will be compared with patients turning 54, 64 and 74 in 2018, controlling for potential covariates including age, gender and socioeconomic status. Interviews with all GPs (n=10) and a minimum of 10 patients will be conducted to gain an understanding of attitudes toward the prompt. Results: To date the prompt has been successfully integrated into the practice and GPs have begun encouraging patients to use their NBCSP kits. Attitudes of GPs and patients toward the prompt and preliminary data on kit usage will also be presented. Conclusion: A clinical prompt in general practice may be a simple and cost effective way to increase participation in the National Bowel Cancer Screening Program. The findings from this study will have implications for the program in terms of engaging GPs in the screening invitation process. The results will further be used to inform a pilot study in Tasmania.

A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening.

Background:The NHS Bowel Cancer Screening Programme in England offers biennial guaiac faecal occult blood testing (gFOBt). There is a socioeconomic gradient in participation and socioeconomically disadvantaged groups have worse colorectal cancer survival than more advantaged groups. We compared the effectiveness and cost of an enhanced reminder letter with the usual reminder letter on overall uptake of gFOBt and the socioeconomic gradient in uptake.Methods:We enhanced the usual reminder by including a heading ‘A reminder to you' and a short paragraph restating the offer of screening in simple language. We undertook a cluster-randomised trial of all 168 480 individuals who were due to receive a reminder over 20 days in 2013. Randomisation was based on the day of invitation. Blinding of individuals was not possible, but the possibility of bias was minimal owing to the lack of direct contact with participants. The enhanced reminder was sent to 78 067 individuals and 90 413 received the usual reminder. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Data were analysed by logistic regression with conservative variance estimates to take account of cluster randomisation.Results:There was a small but statistically significant (P=0.001) increase in participation with the enhanced reminder (25.8% vs 25.1%). There was significant (P=0.005) heterogeneity of the effect by socioeconomic status with an 11% increase in the odds of participation in the most deprived quintile (from 13.3 to 14.1%) and no increase in the least deprived. We estimated that implementing the enhanced reminder nationally could result in up to 80 more people with high or intermediate risk colorectal adenomas and up to 30 more cancers detected each year if it were implemented nationally. The intervention incurred a small one-off cost of £78 000 to modify the reminder letter.Conclusions:The enhanced reminder increases overall uptake and reduces the socioeconomic gradient in bowel cancer screening participation at little additional cost.

A qualitative investigation of factors influencing participation in bowel screening in New South Wales.

Issue addressed Bowel cancer is Australia's second biggest cancer killer. Yet, despite the existence of a free national bowel-screening program, participation in this program remains low. The aim of the present study was to understand the current factors contributing to this trend to help inform future strategies to increase participation. Methods Eight focus groups (n=61 in total) were conducted with participants aged 45 years and over from metropolitan and regional New South Wales (NSW). Discussions canvassed awareness, knowledge, attitudes and beliefs regarding bowel cancer and screening, and explored how these factors influenced decisions to screen. Results The low public profile of bowel cancer compared with other cancers, together with poor knowledge of its prevalence and treatability, has contributed to a low perception of risk in the community. Minimal understanding of the often-asymptomatic presentation of bowel cancer and the role of screening in prevention has appeared to compromise the perceived value of screening. In addition, confusion regarding when, and how often, individuals should screen was apparent. Knowledge of bowel cancer and screening, and its role in motivating intention to screen, emerged as a dominant theme in the data. Conclusions The present study highlights specific knowledge gaps and confusion with regard to bowel cancer and screening. Addressing these gaps through the provision of clear, coordinated information may shift attitudes to screening and increase participation. So what? Given the Australian Government's recent commitment to expand the National Bowel Cancer Screening Program, insight into what is driving current perceptions, attitudes and subsequent participation in bowel cancer screening is crucial to the development and targeting of new approaches and initiatives.

Reasons for non-participation in the Northern Ireland Bowel Cancer Screening Programme: a qualitative study

ObjectivesTo identify the reasons why some people do not participate in bowel cancer screening so that steps can be taken to improve informed decision-making.DesignQualitative study, using focus groups with thematic...

A randomised controlled trial of personalised decision support delivered via the internet for bowel cancer screening with a faecal occult blood test: the effects of tailoring of messages according to social cognitive variables on participation.

BackgroundIn Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables.MethodsA parallel, randomised controlled, trial invited 25,511 people aged 50–74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample).ResultsFOBT return: In the ITT sample, there was no significant difference between any group (χ2(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ2(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ2(1) = 2.23, p = .13). Age was positively associated with kit return.Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42).Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging.ConclusionsOnline information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000095066

Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing

BackgroundThe English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60–69 years since 2006, and to those aged 60–74 years since 2010. Analysis...