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.

Download Full-text

A Whole-Organisation Approach to Increasing Bowel Screening Participation Rates

Journal of Global Oncology ◽

10.1200/jgo.18.26400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 147s-147s

Author(s):

K. Broun ◽

T. Harper

Keyword(s):

Screening Program ◽

Bowel Cancer ◽

Motivating Factors ◽

Participation Rates ◽

Innovative Strategies ◽

Screening Participation ◽

Cancer Screening Program ◽

Cancer Council ◽

Program Policy ◽

Bowel Cancer Screening

Background and context: Australia has one of the highest rates of bowel cancer in the world, yet if detected early more than 90% of cases can be successfully treated. The Australian government's National Bowel Cancer Screening Program (NBCSP) send a free at-home iFOBT to all eligible people aged 50-74. Current uptake of the program is low (∼40%). Increasing bowel screening is a key focus of Cancer Council Victoria's (CCV) strategic plan (2017-2021). Aim: CCV aims to increase NBCSP participation rates in the state of Victoria, Australia to 50% by 2021. Strategy/Tactics: In 2017, CCV implemented its first ever television-led bowel screening campaign. A whole-organization approach was adopted to develop, implement and evaluate the campaign. Program/Policy process: A whole-organization approach included working with CCVs behavioral researchers to understand barriers and motivating factors to screen, collaboration with the epidemiology center to identify evidence to target campaign delivery, stakeholder liaison with clinicians engaged with the organization, engagement with the organization's support services to respond to calls as a result of the campaign, working with the fundraising team to develop strategies to engage supporters, and leveraging our flagship Daffodil Day initiative with a focus on bowel cancer. Outcomes: Adopting a whole-organization approach enabled all facets of the organization to be involved in a common goal. This resulted in shared ownership of campaign deliverables, greater engagement of staff across the organization in bowel screening and the identification of innovative strategies that wouldn't have been possible had this approach not been adopted. Importantly, CCV’s campaign led to greater numbers of eligible people participating in bowel screening. What was learned: The identification of bowel screening as a CCV priority was critical for enabling cross-organizational collaboration. Taking a whole-organization approach resulted in the identification of existing programs and services to leverage the campaign, strengthening its reach and overall impact.

Download Full-text

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

Journal of Global Oncology ◽

10.1200/jgo.18.25400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 52s-52s

Author(s):

S. Lee ◽

B. Bowring ◽

A. Cooper ◽

M. Gardiner

Keyword(s):

General Practice ◽

Cancer Screening ◽

Screening Program ◽

Point Of Care ◽

Bowel Cancer ◽

Screening Programs ◽

Screening Participation ◽

Cancer Screening Program ◽

Number Of Patients ◽

Bowel Cancer Screening

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.

Download Full-text

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

Journal of Medical Screening ◽

10.1177/0969141319874372 ◽

2019 ◽

Vol 27 (1) ◽

pp. 18-24

Author(s):

Sarah Durkin ◽

Kate Broun ◽

Nicola Guerin ◽

Belinda Morley ◽

Melanie Wakefield

Keyword(s):

Cancer Screening ◽

Mass Media ◽

Screening Program ◽

Bowel Cancer ◽

Mass Media Campaign ◽

Media Campaign ◽

Screening Participation ◽

Cancer Screening Program ◽

Bowel Cancer Screening ◽

Cancer Screening Participation

Objective To examine the effect of a mass media campaign designed to increase bowel cancer screening participation. Methods 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. Results 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). Conclusions 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.

Download Full-text