Timely reminders may boost bowel cancer screening

Automated reminders can in improve participation in younger, male, non-Caucasian and disadvantaged populations.

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Certain groups of patients consistently don’t participate in bowel cancer screening, but a few tricks might help.  

The National Bowel Cancer Screening Program has the lowest participation rate of the Australia’s three population-based cancer screening programs, trailing behind the cervical and breast cancer iterations. Similar programs overseas struggle to engage asymptomatic individuals to return the faecal occult blood tests. 

But a new retrospective cohort study of nearly 40,000 UK patients with symptoms of suspected colorectal cancer found 10% of patients failed to return the home FOBT kit after the first request.  

Noncompliance was seen more in certain groups: the odds of males failing to return the test were 11% higher, in people under age 65 it was 38% higher, in ethnic minorities it was 29-82% higher and in those facing the greatest socioeconomic disadvantage it was 120% higher. 

These findings were consistent with monitoring data from the Australian screening program, which found lower participation rates in males than females (39% versus 43%), younger people compared with older people (32% of those aged 50-54 versus 52% of those aged 70-74), Indigenous Australians compared with non-Indigenous Australians (31% versus 41%) and in lower socioeconomic areas (37% versus 45%). 

One difference to the Australian system is that in recent years the UK has begun giving FOBTs to patients with lower gastrointestinal symptoms – excluding rectal bleeding or masses – to assess risk. Future interventions such as referral for colonoscopy, repeat tests and primary care management are guided by the results of the FOBT. 

As a result, the study cohort was motivated, which the authors said may have removed or reduced common barriers found in asymptomatic populations such as embarrassment or fear. 

However, the fact that one in ten patients with suspected cancer symptoms did not return their test kit suggested barriers such as “masculine ideologies, fearful health beliefs and lower health awareness” still existed, the authors said.   

Dr Oliver Frank, an Adelaide-based GP and researcher, is familiar with the challenges in trying to improve participation rates in preventive activities. Dr Frank has used Doctors’ Control Panel, a computer software designed to help GPs and practice nurses monitor a patient’s adherence to recommended guidelines, in his research for more than a decade. 

“[The software] will look into a patient’s record to see what [tests or vaccines] are due for that patient, and then sends them an SMS reminder right before the appointment that says, ‘please ask me about this in the consultation today’,” Dr Frank told The Medical Republic. 

“This gives people the chance to ask the doctor without any time, effort or cost, because they’re already about to see the doctor.” 

Dr Frank recently completed a trial for reminders about influenza and pneumococcal vaccinations in high-risk populations and is currently running a small trial using automated reminders to increase participation in bowel cancer screening.  

“The reminders fit in with our current idea that we want patients to be active in their own care. If the patient comes in and raises the topic with the GP by saying, ‘I got your message about bowel cancer screening’ then it’s very hard for the doctor not to act on it. We think it will have a positive effect,” said Dr Frank.   

Healthcare providers can also bulk order free FOBT kits from the National Bowel Cancer Screening Program to hand out to patients during consultations. Pathology practices also provide the kits.  

“The physical act of being with the doctor, and the doctor explaining to the patient how to use it is a very strong factor [in the patient completing the test],” Dr Frank explained. 

British Journal of General Practice 2023, online 16 October 

Dr Frank has collaborated informally with the developer of Doctors’ Control Panel but has no financial interest in the software and has not received payment from Doctors’ Control Panel Pty Ltd.