Results from 2.6 million invitations between : 54% overall uptake (von Wagner et al., 2011)

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1 TRICCS: Text-message Reminders in Colorectal Cancer Screening Research Department of Behavioural Science and Health University College London Christian von Wagner ) Background Colorectal cancer (CRC) is the fourth most common cancer in the United Kingdom The NHS Bowel Cancer Screening Programme (BCSP) offers biennial guaiac faecal occult blood testing (gfobt) to men and women aged Results from 2.6 million invitations between : 54% overall uptake (von Wagner et al., 2011) Strong evidence on social inequalities (Uptake: 35% in lowest vs 61% in least deprived quintile) London is lowest amongst other hubs (Uptake 38%) Uptake at first-time invitation is the strongest predictor of repeat uptake in the second round of invitations (Lo et al, 2015). Recent evaluation of CRUK interventions had a significantly stronger impact among first-time invitees compared with those who had previously been invited (White et al, 2015). 1

2 Use of Mobile Health Technology in Cancer Screening Non-clinical Interventions Breast Screening: Strong evidence from research on breast cancer screening uptake [59% in the control and 64% in reminder group], and social inequalities in London [48.5% and 62.1% in most deprived ](Kerrison et al., 2015) Colorectal Cancer Screening: Multi-component reminders are effective to improve CRC uptake (usual care: 37% vs postal + phone + text reminder: 82%, Baker et al., 2014) Methods Week 0 Week 1 Week 4 Week 8 Week 8 Week 18 Invitation Sent Kit Dispatched Reminder Letter Randomisation Intervention Usual Care Text-Message Reminder End of gfobt Episode End of gfobt episode Research Questions: 1) Is a primary-care based text-message reminder an effective intervention to improve uptake of Bowel Cancer Screening in London on an intention-totreat basis? 2) Are there any subgroup differences between first-time and repeat invitees? 2

3 The end of gfobt Screening Episode Week 0 Week 1 Week 4 Week 8 Week 8 Week 18 Invitation Sent Kit Dispatched Reminder Letter Randomisation Intervention Usual Care Text-Message Reminder End of gfobt Episode End of gfobt episode Research Question: 1) Is a primary-care based text-message reminder an effective intervention to improve uptake of Bowel Cancer Screening in London on an intention-totreat basis? 2) Are there any subgroup differences between first-time and repeat invitees? Methods and Data Collection (n=8269) 3

4 Intention-to-treat analysis (N=8269) The total proportion of people adequately screened at the end of each individual s screening episode (Intention-to-treat). Control 39.9% (1648 out of 4135) Intervention 40.5% (1674 out of 4134) OR 1.03 C.I. ( ), p=.56 Note: Model is adjusted for age, gender, IMD quintile, CCG, and episode sequence number. Subgroup Analysis Gender Age IMD Control (n=4135) Intervention (n=4134) OR (95% CI) Female 42.0 (916) 43.5 (921) Ref P-value Male 37.4 (732) 37.3 (753) 0.95 ( ) (694) 39.2 (713) Ref (510) 40.2 (498) 0.86 ( ) (444) 43.2 (463) 0.95 ( ) 0.64 Quintile (176) 51.1 (187) Ref Quintile (232) 44.2 (253) 1.29 ( ) 0.19 Quintile (432) 44.3 (456) 1.11 ( ) 0.54 Quintile (485) 38.3 (777) 1.06 ( ) 0.74 Quintile (557) 32.3 (278) 0.88 ( ) 0.50 Clinical Commissioning Groups Invitation Status Croydon 46.1 (416) 48.0 (427) Ref Greenwich 44.2 (387) 42.4 (355) 1.04 ( ) 0.81 Hammersmith 36.1 (100) 35.7 (107) 0.91 ( ) 0.54 &Fulham Hounslow 37.9 (314) 42.4 (346) 0.98 ( ) 0.91 Lewisham 37.9 (259) 37.1 (247) 1.18 ( ) 0.32 West London 30.2 (172) 30.7 (192) 0.94 ( ) 0.73 First-time invitees 34.9 (282) 40.5 (297) 1.30 ( ) 0.02 Repeat Invitees 41.1 (1366) 40.5 (1377) Ref All results were adjusted by age, gender, CCG, IMD quintile, invitation status; *p<.05, ***p<.001 4

5 Sub-group analysis Control= 35% vs Intervention 41%, OR=1.30 (95% CI ), p=.027 Note: Model is adjusted for age, gender, IMD quintile, CCG, and invitation status. Conclusion The intention-to-treat analysis showed that a textmessage reminder was not effective at improving uptake of adequate gfobt screening within six CCGs in London. A text-message reminder may have been effective at promoting uptake of gfobt uptake among first-time invitees. 5

6 Strengths and limitations This is the first large-scale trial examining the effectiveness of text-message reminders in the context of gfobt-based CRC screening in a nationally organised programme. Possible inaccurate and out-of-date mobile numbers and low proportions of people with registered mobile phone numbers in primary care raise concerns that GP clinical records for mobile phone numbers may not be up-to-date. Discussion Future Recommendations Changing the timing of the text-reminder Focusing on first time participants Updated GP records Change the message? No warning: Can we use an opt-out message to pre-engage people? It is possible that adding a notification of the additional textmessage reminder from primary care to the BCSP materials sent alongside the gfobt kit would have helped people to anticipate that the purpose of the text-message was to act as a reminder for the CRC screening. 6

7 Acknowledgements Co-authors Dr Yasemin Hirst Mr Robert Kerrison Dr Lindsay Kobayashi Dr Nick Counsell Dr Natasha Djedovic Dr Jospehine Ruwende Mr Mark Stewart Acknowledgements London North West Healthcare NHS Trust Cancer Research UK Bowel Cancer Screening London Hub iplato CCG cancer leads and Cancer Research UK GP facilitators 7

8 Any Questions? Hirst, Y., Kerrison, R., Kobayashi, L. C., Counsell, N., Djedovic, N., Ruwende, J., von Wagner, C. (2016). Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial. BMC Public Health, 16(1), 74. doi: /s