Turning Intention Into Behaviour: The Effect of Providing Cues to Action on Participation Rates for Colorectal Cancer Screening

ObjectivesCancer screening is a form of secondary prevention for a disease which is now the leading cause of death in France. Various socioeconomic indicators have been identified as potential factors for disparities in breast, cervical and colorectal cancer screening uptake. We aimed to identify the socioeconomic inequalities, which persisted in screening uptake for these cancers, and to quantify these disparities over a 5-year period.SettingThe Cancer Barometer was a population-based-survey carried out in 2005 and 2010 in France.ParticipantsA randomly selected sample of participants aged 15–85 years (n=3820 in 2005 and n=3727 in 2010) were interviewed on their participation in breast, cervical and colorectal cancer screening-programmes and their socioeconomic profile.Primary and secondary outcome measuresFor each type of screening programme, we calculated participation rates, OR and relative inequality indices (RII) for participation, derived from logistic regression of the following socioeconomic variables: income, education, occupation, employment and health insurance. Changes in participation between 2005 and 2010 were then analysed.ResultsParticipation rates for breast and colorectal screening increased significantly among the majority of socioeconomic categories, whereas for cervical cancer screening there were no significant changes between 2005 and 2010. RIIs for income remained significant for cervical smear in 2005 (RII=0.25, 95% CI 0.13 to 0.48) and in 2010 (RII=0.31, 95% CI 0.15 to 0.64). RIIs for education in mammography (RII=0.43, 95% CI 0.19 to 0.98) and cervical smear (RII=0.36, 95% CI 0.21 to 0.64) were significant in 2005 and remained significant for cervical smear (RII=0.40, 95% CI 0.22 to 0.74) in 2010.ConclusionsThere was a persistence of socioeconomic inequalities in the uptake of opportunistic cervical cancer screening. Conversely, organised screening programmes for breast and colorectal cancer saw a reduction in relative socioeconomic inequalities, even though the results were not statistically significant. The findings suggest that organised cancer screening programmes may have the potential to reduce socioeconomic disparities in participation.

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Participation rates for organized colorectal cancer screening programmes: an international comparison

Journal of Medical Screening ◽

10.1177/0969141315584694 ◽

2015 ◽

Vol 22 (3) ◽

pp. 119-126 ◽

Cited By ~ 65

Author(s):

Carrie Klabunde ◽

Johannes Blom ◽

Jean-Luc Bulliard ◽

Montse Garcia ◽

Lea Hagoel ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

International Comparison ◽

Participation Rates

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Meaningful reporting in primary care: An evaluation of the screening activity report.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.173 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 173-173

Author(s):

Nicki Cunningham ◽

Christine Stogios ◽

Shama Umar ◽

Dafna Carr ◽

Jason Garay ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Clinical Guidelines ◽

Participation Rates ◽

Screening Participation ◽

The Impact ◽

Screening Activity ◽

Activity Report

173 Background: Cancer Care Ontario (CCO) developed the ColonCancerCheck Screening Activity Report (CCC SAR) as a supplementary tool for primary care physicians (PCPs) who are part of a patient enrolment model in Ontario, Canada to support them in increasing their colorectal cancer screening rates and appropriate follow-ups. The report provides PCPs with a summary of their eligible patients’ colorectal cancer screening-related history and was designed with the intent of supporting both population health management and opportunistic screening. Delivered through an online platform, the SAR offers PCPs access to data to facilitate quality cancer screening practices aligned with CCO’s evidence-based clinical guidelines. Methods: The report leverages provincial datasets to summarize screening activities on a per-patient level and actionable follow-up recommendations based on CCO’s clinical guidelines. To evaluate the impact of the reports on colorectal screening participation rates, a Generalized Estimating Equation model was used. Results: Results on the report’s impact on colorectal cancer screening participation rates from the first release (February 2013) are promising. By identifying for PCPs which patients are overdue for screening, the SAR demonstrated a modest and statistically significant 6% increased likelihood of patients being screened using a Fecal Occult Blood Test (FOBT) if their PCP was registered to access the online report, compared to patients of unregistered PCPs. The impact to screening increased to 25% when comparing registered PCPs who logged in and viewed their SAR to registered PCPs who did not login; however, this analysis is at a greater risk of a volunteer bias. Such PCPs may be more likely to screen their patients independent of viewing their SAR. Conclusions: By equipping PCPs with patient-level data grounded in CCO’s evidence-based clinical guidelines, the SAR is innovative in its potential to increase screening rates and the appropriate follow-up of abnormal results. The successful launch of two online CCC SARs, sharing meaningful colorectal cancer screening data to frontline providers, has driven the report’s expansion to include breast and cervical cancer screening data in spring of 2014.

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Mo1928 Improving Participation Rates in Community-Based Colorectal Cancer Screening - Role of a Blood Test As a Novel Biomarker

Gastroenterology ◽

10.1016/s0016-5085(15)32537-3 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-741-S-742

Author(s):

Erin L. Symonds ◽

Susanne K. Pedersen ◽

Stephen R. Cole ◽

David Murray ◽

Joe Massolino ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Blood Test ◽

Participation Rates ◽

Community Based

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Factors influencing colorectal cancer screening participation rates in 2016

Annals of Oncology ◽

10.1093/annonc/mdx261.256 ◽

2017 ◽

Vol 28 ◽

pp. iii90-iii91

Author(s):

Jérôme Viguier ◽

Jean-François Morere ◽

Xavier Pivot ◽

Alexis B. Cortot ◽

Jean-Yves Blay ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Participation Rates ◽

Factors Influencing ◽

Screening Participation ◽

Cancer Screening Participation

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Organized colorectal cancer screening: the participation rate according to the precariousness

European Journal of Public Health ◽

10.1093/eurpub/ckz186.695 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

S Arlotto ◽

E Le Cozannet ◽

Y Rinaldi ◽

S Gentile ◽

P Heid ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Average Rate ◽

Participation Rate ◽

Age Group ◽

Participation Rates ◽

Association Management ◽

Cancer Screening Program

Abstract Background The National Organized Colorectal Cancer Screening Program (DOCCR) was introduced in 2008. The participation rate in France is much lower than the European recommendations (33.5% versus 45%). There are significant disparities across France. The objective was to assess whether there are disparities in participation rates within the Bouches-du-Rhône(BdR) department and to study the possible correlation of these geographical areas with their level of precariousness. Methods Based on data collected by the ARCADES association (management structure in charge of cancer screening in the BdR region), 325,207 people in 2012 and 489,953 in 2017 were invited to participate in the DOCCR. The participation was analysed in two aspects: participation rate (TP) (test carried out) and participation rate of those who took a test or expressed a justified refusal (TPJ) (personal or family history, other test under 2 years old, colonoscopy under 5 years old). An average precariousness rate was also assessed per municipality based on 2012 INSEE data for the age group concerned. Results The TP were 18.9% in 2012 and 14.4% in 2017; the TPJ were 22.8% and 16.4% respectively and differs significantly between the municipalities in the department (p < 0.001). The average precariousness rate observed in our population was 12.3 (±8.2). The TPJ is inversely correlated with the precariousness rate: the higher the latter, the lower the participation rate (R=-0.58 in 2012, R=-0.539 in 2017; p < 0.05). The average participation rate whatever the year is lower for municipalities with a precariousness rate below the median (19.2 ± 2 versus 16.9 ± 3.5 for the year 2017). Conclusions Participation rates in 2012 and 2017 are lower than the European recommendations. The participation is significantly related to the average rate of precariousness; the most vulnerable participate less well. Specific actions towards the most vulnerable are to be considered in order to improve adherence to the DOCCR. Key messages The participation organized colorectal cancer screening program is significantly related to the average rate of precariousness. Specific actions towards the most precarious are to be considered in order to improve adherence to the DOCCR.

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Invitation letters increase participation in colorectal cancer screening – results from an observational study

Zeitschrift für Gastroenterologie ◽

10.1055/s-0043-121347 ◽

2017 ◽

Vol 55 (12) ◽

pp. 1307-1312 ◽

Cited By ~ 2

Author(s):

Tianzuo Zhan ◽

Thomas Hielscher ◽

Asmé Bilge ◽

Thomas Giese ◽

Christoph Schäfer ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Screening Colonoscopy ◽

Moderate Increase ◽

Participation Rates ◽

Invitation Letter ◽

Insurance Claims Data ◽

The Impact

Abstract Background and Aim Participation rates in the German colorectal cancer screening program are low. Starting in 2013, a large health insurance plan in Bavaria, Germany, is sending an additional invitation letter to insured individuals when they turn 50 or 55 years and become eligible for participation in the program. The letter provides detailed information on colorectal cancer screening. We assessed the impact of the invitation letter on utilization rates. Methods Insurance claims data of a total of 48 343 individuals who had turned 50 or 55 years between 2012 to 2014 were reviewed for utilization rates of screening colonoscopy and fecal blood tests. Utilization rates 1 year prior (2012) and 2 years after introduction of the invitation letter (2013 and 2014) were compared. Furthermore, providers of colorectal cancer screening were determined. Results Within 6 months after turning 50 or 55 years, 8.8 – 10.2 % of all insured individuals participated in colorectal cancer screening, with the majority being females. After the introduction of the invitation letter, a moderate increase in participation rates could be observed (increase to 109 % [RR 101.7 – 117.3 %, p = 0.02] in 2014). The uptake rate of screening colonoscopy was significantly higher in recipients of the letter (increase to 138.4 % [RR 110.4 – 173.8 %, p = 0.0043] in 2013 and to 149 % [RR 119.5 – 186.3 %, p = 0.0003] in 2014). Furthermore, a significantly higher proportion of general practitioners and gastroenterologists provided colorectal cancer screening in individuals receiving the invitation letter. Conclusions Introduction of an invitation letter can improve participation rates for colorectal cancer screening.

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