Evidence map›Paper›PMID 26680217›Full record

Trial reportLancet (London, England)2016

Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials.

Jane Wardle, Christian von Wagner, Ines Kralj-Hans, Stephen P Halloran, Samuel G Smith, Lesley M McGregor, Gemma Vart, Rosemary Howe, Julia Snowball, Graham Handley and 11 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05609396 (Interventions to Improve Bowel Cancer Screening Uptake in Ireland), which is not on this map. Cited by 66 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
66citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05609396 nacompletednot on this mapstarted 2022, after this paper: background citation

Interventions to Improve Bowel Cancer Screening Uptake in Ireland: a 2x2 Factorial Trial

TypeinterventionalSponsorDublin City UniversityRan2022 to 2022Enrolled8,734ConditionsColorectal CancerArmsBehaviorally enhanced reminder letter
3 · Its place in the literature

Who cites it

66 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  4. Targeted encouragement of GP consultations for possible cancer symptoms: a randomised controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021
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6 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Jane WardleDepartment of Epidemiology and Public Health, University College London, London, UK.
Christian von WagnerDepartment of Epidemiology and Public Health, University College London, London, UK. Electronic address: c.wagner@ucl.ac.uk.
Ines Kralj-HansDepartment of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Stephen P HalloranNHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, and University of Surrey, Guildford, UK.
Samuel G SmithDepartment of Epidemiology and Public Health, University College London, London, UK; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Lesley M McGregorDepartment of Epidemiology and Public Health, University College London, London, UK.
Gemma VartDepartment of Epidemiology and Public Health, University College London, London, UK.
Rosemary HoweDepartment of Surgery and Cancer, Imperial College London, London, UK.
Julia SnowballNHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK.
Graham HandleyNHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK.
Richard F LoganNHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK.
Sandra RainbowNHS Bowel Cancer Screening Hub, London Hub, Northwick Park and St Mark's Hospital, Harrow, Middlesex, UK.
Steve SmithNHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK.
Mary C ThomasDepartment of Applied Health Research, University College London, London, UK.
Nicholas CounsellCancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK.
Steve MorrisDepartment of Applied Health Research, University College London, London, UK.
Stephen W DuffyWolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Allan HackshawCancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK.
Sue MossWolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Wendy AtkinDepartment of Surgery and Cancer, Imperial College London, London, UK.
Rosalind RaineDepartment of Applied Health Research, University College London, London, UK.

Funding

Cancer Research UK 14134Cancer Research UK 16894Cancer Research UK 17965Cancer Research UK A17965Department of Health RP-PG-0609-10106
6 · The paper itself

Abstract

backgroundUptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening.

methodsAll people eligible for screening (men and women aged 60-74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July-August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020.

findingsAs all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163,525) and 2 (n=150,417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04-1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04-1·20, p=0·003) than in the least deprived (1·00, 0·94-1·06, p=0·98). Overall uptake was also increased (1·07, 1·03-1·11, p=0·001).

interpretationOf four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging.

fundingNational Institute for Health Research.

Indexed as

Social ClassAgedColorectal NeoplasmsCorrespondence as TopicEarly Detection of CancerEnglandEvidence-Based MedicineFemaleHumansMaleMass ScreeningMiddle AgedOccult BloodPatient Acceptance of Health CareReminder SystemsState Medicine

Identifiers

PMID26680217
PMCPMC4761689

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.