Past bowel cancer screening campaigns

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As part of Cancer Research UK's efforts to beat bowel cancer sooner, three previous bowel cancer screening pilot projects have been conducted to date. All three pilots have aimed to increase participation in the NHS Bowel Cancer Screening Programme (guaiac faecal occult blood test or gFOBT) by raising awareness of the programme (i.e. benefits/eligibility) and reducing barriers to participation.

The pilot projects ran in London (Feb – March 2014), Wales (Feb – March 2015) and England (Aug 2015 – April 2016). Insight gained from this activity has informed our 2016 campaign plans.

The 2014 London pilot

The London pilot project tested four interventions.

Interventions  tested

Description

Intervention group A

Endorsement flyer

An A5 CRUK endorsement flyer from CRUK (endorsing the NHS Bowel Cancer Screening programme), which was sent in the same mailing as the NHS gFOBT kit

Intervention group B

Endorsement flyer + kit enhancement pack (gloves & poo catcher)

Endorsement flyer + x3 ‘kit enhancement packs’, each containing a ‘poo catcher’ and 1x pair of latex-free gloves, sent as a separate mailing, arrived 2 days following the NHS gFOBT kit

Intervention group C

Endorsement flyer + advertising

Endorsement flyer + advertising (posters in bus shelters, local newspapers, adverts on pharmacy bags and in GP and dentist waiting rooms)

Intervention group D

Endorsement flyer +

Kit enhancement pack (gloves & poo catcher) + advertising

Endorsement flyer + ‘kit enhancement pack’ + advertising

Findings published in October 2015 by White et al, show that all of the intervention groups apart from the endorsement flyer alone (intervention group A) successfully increased uptake of bowel cancer screening in 60-69 year olds. When the flyer was combined with either the kit enhancement pack (intervention B) or with the advertising (intervention C), there were small but significant increases in uptake. However, the largest increases were seen when all three resources were combined (Intervention group D). Among 70-74 year olds, uptake was also highest in intervention group D. 

The increased uptake in the intervention groups was largest in “First-Timers” and smaller amongst Previous Non-Responders and Previously Screened invitees[1].

Interventions  tested

Overall increase in uptake

Ages 60-69

Overall increase in uptake

Ages 70-74

Intervention group A

Endorsement flyer

                -

                -

Intervention group B

Endorsement flyer + kit enhancement pack

               1.7%

               -

Intervention group C

Endorsement flyer + advertising

                2.2%

               -

Intervention group D

Endorsement flyer +

kit enhancement pack + advertising

               6.1%

            7.3%

[1] First-timers were defined as those being invited to screening for the First Time (First Prevalent Round), Previous Non-Responders (Subsequent Prevalent Round) were those who had been invited before but had never returned a used test kit, and ‘Previously Screened’ (Incident round) were those who had been invited before and successfully returned a used test kit.

Read the full evaluation paper

Read more on evidence for effective methods of improving bowel screening uptake

The 2015 Wales pilot

A second pilot ran across Wales from February to early April 2015 and aimed to further explore the impact and cost effectiveness of the interventions tested in the London pilot. This project aimed to test the individual impact of each intervention and trial different ways of implementing them. The pilot was conducted in partnership with Bowel Screening Wales.

Interventions  tested

Description

Intervention group A

Endorsement letter

A4 personalised CRUK endorsement letter, outlining the benefits (and risks) of participating in the NHS bowel cancer screening programme and providing a recommendation from CRUK to complete the test. Letter arrived two days following an NHS gFOBT kit.

Intervention group B

Endorsement letter + kit enhancement pack (gloves)

CRUK endorsement letter + kit enhancement pack containing x3 pairs of latex free gloves only. Arrived two days following and NHS gFOBT kit.

Intervention group C

Endorsement letter + kit enhancement pack (gloves & poo catcher)

CRUK endorsement letter + x3 kit enhancement packs, each containing x1 pair of latex free gloves and x1 poo catcher. Arrived two days following and NHS gFOBT kit.

Intervention group D

Advertising

Advertising only (posters in bus shelters, on interior and exterior of buses, on phone kiosks, in local newspapers and on pharmacy bags).

Findings show that all of the intervention groups apart from advertising alone (intervention group D) successfully increased uptake of bowel cancer screening in one or more of the screening history groups (i.e. First Timers, Previous Non-Responders or Previously Screened invitees). However, overall, sending patients a personalised CRUK endorsement letter (intervention group A), had the largest impact on uptake, particularly among First Timers where a maximum 9.1% increase was observed. Further investigation of the impact of each intervention by deprivation score also revealed that sending an endorsement letter plus a kit enhancement pack containing x3 pairs of gloves (intervention group B) had the greatest impact among more deprived Non-Responders – a particularly difficult group to engage. Advertising alone (intervention D) did not increase uptake in Wales among any of the screening history groups and it was significantly lower among Previously Screened invitees.

The increased uptake in the intervention groups was largest in First Timers and smaller amongst Previous Non-Responders and Previously Screened invitees.

12-week uptake results amongst 60-74 year olds, by screening history group

The table shows percentage point increase in uptake in each intervention group compared to controls.

Intervention

First Timers

Previous

Non-Responders

Previously Screened

Intervention A

CRUK endorsement letter

+9.1%*

+2.6%*

+1.4%*

Intervention B

Endorsement letter + pack (gloves)

+5.5%*

+2.3%*

-0.94%

Intervention C

Endorsement letter + pack (gloves & poo-catcher)

+3.1%

+2.4%*

-1.2%

Intervention D

Advertising

+1.9%

+0.67%

-1.6%*

* indicates that the difference was statistically significant at a 95% confidence level
 

The 2015/16 England campaign

A recent Cancer Research UK bowel cancer screening advertising campaign ran in 7 regions (32 CCG areas) of England (see below) from August 2015 to April 2016. This campaign was supported by NHS England, Department of Health and Public Health England.

A long-term approach was applied to this campaign, with media running in four consecutive bursts over an eight month period. The aim of this media strategy was to reach, and be relevant to a greater number of the eligible population (60 – 74 year olds) than if the campaign were to run over a shorter period.

Direct mail was also planned to run alongside advertising from March to April 2016 however delays associated with access to PHE patient data prevented this activity from being implemented.

A long-term advertising campaign which ran in the following 7 regional areas (32 CCG areas) from August 2015 to April 2016.

  • Lancashire (Blackpool and West Lancashire CCGs)
  • Merseyside (Knowsley, Liverpool, South Sefton, Halton and St Helens CCGs, plus Warrington, Wirral and Southport and Formby CCGs in burst four only)
  • Greater Manchester (all 12 CCGs)
  • Yorkshire (Bradford City, Bradford Districts & Hull CCGs)
  • North East (Newcastle West, Newcastle North, and South Tees CCGs)
  • Leicester (Leicester City CCG)
  • South (Oxfordshire, South Reading & Slough CCGs)

The advertising included posters in bus shelters; posters on telephone kiosks; posters inside and on the outside of buses; adverts on pharmacy bags and regional press articles, during the following dates:

  • Burst one: 24th August to 27th September
  • Burst two: 5th October to 8th November
  • Burst three: 18th January to 21st February
  • Burst four: 21st March to 24th April 2016

We are currently analysing the results from the 2015 campaign to examine the impact of a long-term advertising campaign on uptake and awareness of the NHS bowel cancer screening programme. Results will be available later this year.

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