The English experience of attempts to increase uptake to Flexible Sigmoidoscopy

Transcription

1 The English experience of attempts to increase uptake to Flexible Sigmoidoscopy Dr Christian von Wagner & Dr Lesley McGregor Department of Behavioural Science and Health University College London London, UK UCL research team Robert Kerrison Hanna Skrobanski Bernardette Bonello Stephen Morris Honorary and external colleagues Wendy Atkin (Imperial College) John Isitt (Resonant Media) Sarah Marshall (St Mark s Hospital) Andrew Prentice (St Mark s Hospital) Colin Rees (South Tyneside NHS Trust) Hayley Miller (Gateshead Health NHS Trust) Lindy Berkman (Patient Representative)

2 The English NHS Bowel Cancer Screening Programme (BCSP) Bowel Scope Screening guaiac Faecal Occult Blood Testing Flexi-Quest: Predictors of bowel scope screening intentions and uptake Using Specialist Screening Practitioners (SSPs) to increase uptake of the new Bowel Scope Screening Programme: a feasibility study of patient navigation Use of a 12 month reminder with a theory-based leaflet to promote uptake of BSS at St. Mark s Hospital: a three-arm RCT

3 Flexi-Quest: Uptake of Bowel Scope Screening Average uptake is 43.1% (March 2013 to May 2014) Uptake varies across centres (36.8% to 52.0%) Uptake ranges from 32.7% (most deprived area) to 53.2% (least deprived area) Men (44.6%) are significantly more likely to attend than females (41.5%) Areas with a high level of ethnic diversity had significantly lower uptake (38.7%) than all other areas (41.2 to 47.3%) Pilots Wave 1 Wave 2 Final Rollout March 2013 to July 2013 Nov 2013 to March 2014 April 2014 to March 2015 April 2015 to December Centres 16 (22) Centres 17 (39) Centres 23 (62) Centres

4 Flexi-Quest: Barriers to Bowel Scope Screening Study 1: Retrospective Questionnaire Questionnaires sent = 3227 Questionnaires returned = 1478 (45.8%) Had attended BSS = 1138 (77.0%) Had not attended BSS = 260 (17.6%) Missing = 80 (5.4 %) Reason for non attendance (n = 260) N (%) Worried the test would be painful 67 (25.8%) Thought the test would be embarrassing 64 (24.6%) Worried the test would cause harm to their bowel 53 (20.4%) Didn t believe they needed the test 53 (20.4%) Difficult to make an appointment at a time that suited them 44 (16.9%) Did not want to do the enema 38 (14.6%) Never got round to it 27 (10.4%) *Painful and embarrassing 41 (15.8%)

5 Flexi-Quest: Barriers to Bowel Scope Screening Did not respond to invitation Non attenders (n=260) Cancelled their appointment Confirm but then DNA Unclear behaviour pathway Worried the test would be painful 67 Did not respond to invitation 34 (50.7%) Cancelled appointment 26 (38.8%) Confirmed but then DNA 6 (9.0%) Unclear behaviour pathway 1 (1.5%) Thought the test would be embarrassing 64 Did not respond to invitation 35 (54.7%) Cancelled appointment 27 (42.2%) Confirmed but then DNA 2 (3.1%) Unclear behaviour pathway 0 (0%)

6 Flexi-Quest: knowledge questions Did not respond to invitation Knowledge item Non attenders (n=260) Cancelled their appointment Confirmed then DNA Unclear behaviour pathway N correct Bowel scope screening helps prevent bowel cancer 151 (58.1%) Did not respond to invitation (n = 101) 50 (49.5%) Cancelled appointment (n = 107) 66 (61.7%) Confirmed but then DNA 24 (15.9%) Unclear behaviour pathway 11 (7.3%) Attenders (n = 1131) 760 (67.2%) Bowel scope screening is only useful for people with symptoms 196 (75.4%) Did not respond to invitation (n = 104) 74 (37.8%) Cancelled appointment (n = 107) 86 (43.9%) Confirmed but then DNA 27 (13.8%) Unclear behaviour pathway 9 (4.6%) Attenders (n = 1132) 1065 (94.1%)

7 Using Specialist Screening Practitioners (SSPs) to increase uptake of the new Bowel Scope Screening Programme: a feasibility study of patient navigation

8 Patient Navigation Pre-invitation letter 2 weeks Invitation letter (with an appointment note and an information leaflet) Study Invitation Participant Information Sheet, consent form and non-participation postcard 2 weeks to respond Confirmed appointment No confirmation Reminder letter (with an appointment note and an information leaflet) 4 weeks Confirmed appointment 2 weeks to respond No confirmation Patient Navigation Do not attend their appointment: Cancellation letter sent Enema preparation letter and leaflet 2 weeks Attend appointment 2 weeks Appointment cancelled: Cancellation letter sent Patient Navigation

9 Patient Navigation: Results Between 18 th May and 12 th October, 1050 study packs sent out with BSS pre-invitation letters 152 people (14.5%) returned a study consent form and were randomised 16 (1.5%) returned a non-responder postcard PN Group n = 109 Control Group n = 43 Total n = 152 Appointment outcome n (%) n (%) n (%) Confirmed and attended 87 (79.8) 34 (79.1) 121 (79.6) Confirmed but did not attend 4 (3.7) 4 (9.3) 8 (7.2) Did not confirm or attend 12 (11.0) 2 (4.7) 14 (8.6) Appointment cancelled: a new booking to be arranged Appointment cancelled: no new booking to be arranged 4 (3.7) 3 (7.0) 7 (3.9) 2 (0.9) 0 (0) 2 (0.7)

10 Patient Navigation: Results PN Outcome (n = 22) n (%) No answer 10 (45.5) Number not recognised 3 (13.6) Wrong number (person not known) 1 (4.5) Answered call but refused participation 1 (4.5) Answered call, arranged a call back, and then refused participation 2 (9.1) Answered call, spoke with SSP* 2 (9.1) Lost in study 3 (13.6) *Only 1 was audio recorded and documented as delivery of PN

11 Patient Navigation: Results Summary PN intervention, as per our design, is not feasible within the current BSSP structure The programme structure and the regulations within that limit patient navigation as an intervention for non-responders (no phone numbers available) Non answered calls/false numbers: People within South Tyneside are out to cause mischief SSPs anxiety/reluctance to make calls to non-responders A funding bid has gone in to run a study to evaluate patient navigation through General Practice within Hull, UK (Yorkshire Cancer Research) Future work will continue to look at additional reminders and other communication strategies

12 Use of a 12 months reminder and theory-based leaflet to promote uptake of BSS at St. Mark s Hospital: a three-arm RCT Reminder letter & leaflet designed in conjunction with Resonant, a social marketing company specialising in the development of health behaviour interventions. Initial designs informed by: Previous literature of reasons for non-participation Previous literature of effective intervention components Interviews with previously screened adults

13 12 month reminder study: tailored leaflet

14 12 month reminder study: design and results Non-Participant (n = 1503) Randomly selected (n = 1383) Usual Care (n=461) Intervention A (n=461) Intervention B (n=461) No selfreferral letter or leaflet Usual Care (n=461) Follow-up A (n=416) Follow-up B (n=393) 4 weeks No selfreferral letter or leaflet OR= % CI= OR=1.7 95% CI= weeks 0.2% (1) p < % (48) p = % (70) OR=89.0, 95% CI= p < 0.01

15 Research conclusions thus far Conclusions Uptake of the new Bowel Scope Screening Programme is very low. Phone-based interventions by the programme should be aimed at reducing noshows in people who have already shared their contact details. Using locally tailored information improves uptake of reminders and might also be effective in improving first-time uptake.