Evidence map›Paper›PMID 27875518›Full record

Trial reportBritish journal of cancer2016

A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening.

Rosalind Raine, Sue M Moss, Christian von Wagner, Wendy Atkin, Ines Kralj Hans, Rosemary Howe, Francesca Solmi, Stephen Morris, Nicholas Counsell, Allan Hackshaw and 13 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in British journal of cancer, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

  1. Trial
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Rosalind RaineDepartment of Applied Health Research, University College London, London, WC1E 7HB, UK.
Sue M MossWolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M6BQ, UK.
Christian von WagnerCancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK.
Wendy AtkinCancer Screening and Prevention Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, SW7 2AZ UK.
Ines Kralj HansDepartment of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Rosemary HoweDepartment of Surgery and Cancer, Imperial College London, London, UK.
Francesca SolmiUCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
Stephen MorrisDepartment of Applied Health Research, University College London, London, WC1E 7HB, UK.
Nicholas CounsellCancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK.
Allan HackshawCancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK.
Stephen HalloranFaculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
Graham HandleyNorth East Bowel Cancer Screening Programme Hub, Biochemistry Department, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK.
Richard F LoganEastern Bowel Cancer Screening Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK.
Sandra RainbowLondon Bowel Cancer Screening Programme Hub, The Northwest London Hospitals NHS Trust, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Steve SmithMidlands and North West Bowel Cancer Screening Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK.
Julia SnowballSouthern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK.
Helen SeamanSouthern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK.
Mary ThomasNIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
Samuel G SmithCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
Lesley M McGregorCancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK.
Gemma VartResearch Office, University of Roehampton, London SW15 5PU UK.
Jane WardleDepartment of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 7HB, UK.
Stephen W DuffyCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.

Funding

Cancer Research UK 14134Cancer Research UK 15953Cancer Research UK 16894Cancer Research UK 17965Department of Health RP-PG-0609-10106
6 · The paper itself

Abstract

backgroundThe NHS Bowel Cancer Screening Programme in England offers biennial guaiac faecal occult blood testing (gFOBt). There is a socioeconomic gradient in participation and socioeconomically disadvantaged groups have worse colorectal cancer survival than more advantaged groups. We compared the effectiveness and cost of an enhanced reminder letter with the usual reminder letter on overall uptake of gFOBt and the socioeconomic gradient in uptake.

methodsWe enhanced the usual reminder by including a heading 'A reminder to you' and a short paragraph restating the offer of screening in simple language. We undertook a cluster-randomised trial of all 168 480 individuals who were due to receive a reminder over 20 days in 2013. Randomisation was based on the day of invitation. Blinding of individuals was not possible, but the possibility of bias was minimal owing to the lack of direct contact with participants. The enhanced reminder was sent to 78 067 individuals and 90 413 received the usual reminder. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Data were analysed by logistic regression with conservative variance estimates to take account of cluster randomisation.

resultsThere was a small but statistically significant (P=0.001) increase in participation with the enhanced reminder (25.8% vs 25.1%). There was significant (P=0.005) heterogeneity of the effect by socioeconomic status with an 11% increase in the odds of participation in the most deprived quintile (from 13.3 to 14.1%) and no increase in the least deprived. We estimated that implementing the enhanced reminder nationally could result in up to 80 more people with high or intermediate risk colorectal adenomas and up to 30 more cancers detected each year if it were implemented nationally. The intervention incurred a small one-off cost of £78 000 to modify the reminder letter.

conclusionsThe enhanced reminder increases overall uptake and reduces the socioeconomic gradient in bowel cancer screening participation at little additional cost.

Indexed as

Reminder SystemsSocioeconomic FactorsAgedCluster AnalysisColorectal NeoplasmsFemaleHumansMale

Identifiers

PMID27875518
PMCPMC5155361

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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.