Bowel screening resources

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Access our free and evidence-based information, including useful tools and resources, to support GPs to deliver best practice in prevention and early diagnosis.

Here you can find resources and examples of good practice that can support you to plan and deliver bowel screening improvement activity at a local level. 

A growing evidence base has highlighted many interventions that increase uptake of bowel screening, which is currently low, while promoting informed consent.

If you are aware of, or are involved in, projects that could provide further evidence of good practice to support local teams or looking to improve screening uptake and reduce inequalities, please email us at earlydiagnosis@cancer.org.uk.

Our Primary Care good practice guides provide support to health professionals in primary care to get them thinking about how they can support their practice population to increase bowel screening uptake. 

These guides offer an overview of the bowel screening programme, some practical tips and templates such as GP template letters and phone call scripts.

English version

Scottish version 

Welsh version

Bowel screening uptake is lower than other national cancer screening programmes, and there are considerable inequalities between areas and across different demographic groups.

Uptake is lower in men and people from more deprived groups. Evidence suggests that uptake is also lower in ethnic minority communities or people from an ethnic minority background [1] and vulnerable groups, such as those with learning disabilities, although gaps in data availability persist. 

Taking part in screening is an individual choice, but it must be a choice that is equally available to all. 

We believe it is crucial to reduce inequalities in bowel screening uptake and as a minimum ensure that interventions do not exacerbate inequalities. CRUK has developed a guide that offers practical tips to help reduce inequalities, as well as signposting to further resources and information. The guide is currently being reviewed but you can download the latest version here.

The "Making reasonable adjustments to cancer screening" report from Public Health England (PHE), shares examples of adjustments – including easy read resources and case studies – which health professionals and carers can use to help people with learning disabilities take part in all three cancer screening programmes.

PHE’s Improving Health and Lives Observatory (IHAL) has a database of examples of reasonable adjustments, which is constantly updated. If you have adjustments you’d like to share you can upload them to the database, more information can be found on the IHAL website here.

References:

1.    Hirst, Y et al. (2018) Uptake of the English Bowel (Colorectal) Cancer Screening programme: an update 5 years after the full roll-out. European Journal of Cancer 103:267-73

A step-by-step infographic on how to complete the bowel cancer screening test kit and practical tips how to collect the poo sample.

England FIT version

Scotland FIT version

Wales FIT version (English only)

These leaflets are sent with invitations to bowel cancer screening and they include information to support informed choice with respect to bowel screening participation, and information about benefits and harms.

Bowel Cancer Screening Programme (BSCP) resources

Health Professional Engagement Facilitators

CRUK facilitators provide face-to-face, practical support to GP practices to improve cancer outcomes. They can work collaboratively with your practice; offering advice, training and useful resources. The CRUK facilitator programme does not operate in every locality in the UK, however, they do cover most of England and the more urban areas of Scotland, Wales and Northern Ireland.

 

Talk Cancer: Cancer Awareness Training

Our Talk Cancer training workshops for community-based health workers and volunteers, help trainees feel more confident in talking to the public about cancer.

 

Cancer Awareness Roadshow

Our Roadshow nurses visit local communities, raising awareness of cancer risk factors, screening and early detection. We work closely with health partners in each area we visit and help signpost people to local services.

Use our Local Cancer Statistics tool to find and compare statistical information and intelligence about cancer in areas across the UK.

The tool includes data on; bowel cancer screening, cancer incidence, survival and mortality, early diagnosis and tobacco.

What interventions are covered?

GP Endorsement/Primary Care Involvement

A selection of projects undertaken in the primary care setting with the aim of improving bowel screening uptake.

Recommended for:

  • NHS staff
  • practices
  • CCGs
  • cancer alliances
  • those working on sustainability and transformation plans (STPs) for cancer who are planning similar activities in their area
 

Community Awareness Activities

A number of projects undertaken in the community, with the aim of improving awareness of bowel screening among various regions.

Recommended for:

  • local authorities
  • CCGs
  • public health and promotion teams
  • cancer alliances
  • those working on sustainability and transformation plans (STPs) for cancer who are planning similar activities in their area
 

Improving Uptake Project

In Phase 1 of the Improving Bowel Cancer Screening Project, all GP practices in Pennine Lancashire were asked to contact 5+ patients who had not responded to their screening invitation. They chose to either telephone or send a letter, or discuss opportunistically face to face during a consultation. The practices were asked to review these patients 3-4 months later to see if they had subsequently attended, and review the result. GPs were also provided with an information pack and training.

Key findings:

  • Practices were incentivised to take part. Any that demonstrated innovative methods of increasing patient participation were eligible to apply for additional payment
  • Approximately 76 practices returned figures which were then collated and summarised
  • 1,009 patients who had not initially participated in bowel screening were contacted
  • 15.9% of patients subsequently requested replacement bowel screening kits and returned them to the screening hub
  • Subsequent participation was more likely if there had been face to face discussion (35%) than telephone advice (20%), letter (11%) or unknown method of contact (8%)

Location: Pennine Lancashire, Blackburn with Darwen and East Lancashire CCGs

Date: 2014/15

Contact: Dr Neil Smith, Cancer Clinical Lead, neil.smith2@nhs.net

Download report Download presentation

 

Automatic Email Request

In Phase 2 of the project in Lancashire, more links were established between the Bowel Cancer Screening Programme hub (for the North West & Midlands) and each GP Practice via the EMIS web record system. This enabled the direct electronic transfer of registered patients’ bowel screening results from the hub to each practice and also the option for practices to order a replacement test kit on behalf of a previous non-responder via email. Practices were similarly incentivised to take part in Phase 2 of the project.

Key findings:

  • Preliminary data (as at February 2017) shows that 729 requests were made for replacement kits and 317 patients (44%) completed them, 7 abnormal results were recorded from 38 practices
  • The project demonstrates that a large regional screening hub based in an acute hospital setting can work collaboratively with primary care professionals at a local level to achieve health improvement and a good outcome
  • Phase 3 of the project will build on the work already achieved, sharing evidential learning with others and expanding as appropriate

Location: Pennine Lancashire – Blackburn with Darwen and East Lancashire CCGs

Date: 2016/17

Contact: Dr Neil Smith, Cancer Clinical Lead, neil.smith2@nhs.net

Download report

 

Call for a Kit Clinic

The ‘Call for a Kit’ intervention was set up in Lancashire to address previous non-responders. Those who have not completed the kit are invited to an appointment at their GP practice with the BCSP health promotion team. They are shown the kit and a DVD on how to complete it. Questions and anxieties are addressed, and if they agree to complete the test and require a replacement kit, the team phone the screening hub and order a kit on their behalf.

Key findings:

  • 84% of people invited to the clinic actually attend in person; 91% of people attending the clinic have a kit ordered; 58% of people who attended subsequently completed the kit
  • Gender specific clinics were also offered to patients, this worked well and helped subjects overcome issues around cultural dignity, discussing sensitive body parts and aided discussions on how to collect poo
  • The clinic offered 5 different languages to engage with patients who actually attended
  • Next steps include running the Call for a Kit clinics in next cohort of lowest uptake GP practices in each CCG

Location: Lancashire

Date: 2015/16

Contact: Shahida Hanif, BCSP Health Promotion Specialist, Shahida.Hanif@bfwhospitals.nhs.uk

Download report Download evaluation

 

Early Presentation Symptoms

A community-led engagement campaign (the Cancer Collaborative) was set up in North East Lincolnshire to work with healthcare professionals and to raise awareness of the signs and symptoms of cancer. When the bowel screening programme started, the activity was extended to include messages around screening. It draws upon the local experiences and knowledge of communities and practitioners to identify a wide range of solutions that will work locally.

Key findings:

  • Marketing and community involvement materials were developed following audience testing
  • Badges and stickers which could be worn by health professionals were developed and used as a prompt for conversation with patients
  • Bowel screening uptake in North East Lincolnshire increased from 55.2% in 2008 to 59.9% in 2013
  • Consistent ‘reminding’ of the key messages to the local target population has been seen to increase uptake in bowel screening
  • In planning for the future, the team continue to monitor activity and work with primary care to focus on low uptake areas.

Location: North East Lancashire

Date: 2015

Contact: Julie Grimmer, Collaborative Programme Manager, julie.grimmer@nhs.net

Download report

 

Till Receipt Awareness Campaign

Four 99p Stores in Merseyside were chosen to run a bowel screening awareness campaign based on their central locations, and due to their diverse population customer group. The campaign included awareness messages printed on the reverse side of till receipts, which were used at the main till banks. The till receipt included messaging such as: ‘Over 60? Do your bit – return your screening kit. Bowel screening saves lives.’

Key findings:

  • Till receipt campaigns can be a low cost option to marketing awareness messages 
  • There were a number of limitations with the project, which included: difficulties with evaluation e.g. linking increases in participation directly with the campaign, other campaigns running at the same time
  • It is recommended that healthcare partners pay close attention to contracting, ensuring all parties are clear on their commitments and expectations from the start.

Location: Merseyside

Date: 2014

Contact: Marie Coughlin, Screening and Immunisation Manager, marie.coughlin@nhs.net

Download report

 

Barbers Pilot Project

The barber’s project in Blackburn with Darwen was developed, facilitated and delivered by Sadiq Patel who is a BCSP Community Engagement Officer. Ten barbers were recruited to take part in the pilot within two low uptake, high ethnic minority areas. The barbers were supported to plan one week’s bowel cancer screening campaign within their salons and record data on the numbers engaged. They also recorded the key issues raised by local communities.

Key findings:

  • The project was incentivised and barbers received an award once the project was completed
  • Trained volunteers were involved in raising awareness at the barber shops during peak times, including holding weekly information stands in each shop
  • Over 1,600 men were engaged within the salons by the ten barbers (1,099 of these men were below 60, and 671 were between 60-75)
  • The project allowed for 1,770 bowel screening materials to beistributed
  • Utilising barbers in engaging with specific communities was seen to be worthwhile.

Location: Lancashire, Blackburn and Darwen CCG

Date: 2014

Contact: Sadiq Patel, BCSP Community Engagement Officer, Sadiq.Patel@bwdcvs.org.uk

Download report

 

How you can help

We would be interested to hear of any ideas or plans you may have for improving bowel screening uptake. If you would like to get involved, know of existing good practice examples, or relevant events or networks, please get in touch.

If you are aware of or are involved in projects that could demonstrate good practice, or may be useful for other reasons, please complete our case study submission form and email it to: earlydiagnosis@cancer.org.uk.

Download case study submission form

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