The English experience of attempts to increase uptake to Flexible Sigmoidoscopy Dr Christian von Wagner & Dr Lesley McGregor Department of Behavioural Science and Health University College London London, UK UCL research team Robert Kerrison Hanna Skrobanski Bernardette Bonello Stephen Morris Honorary and external colleagues Wendy Atkin (Imperial College) John Isitt (Resonant Media) Sarah Marshall (St Mark’s Hospital) Andrew Prentice (St Mark’s Hospital) Colin Rees (South Tyneside NHS Trust) Hayley Miller (Gateshead Health NHS Trust) Lindy Berkman (Patient Representative)
Transcript
The English experience of attempts to increase uptake to Flexible Sigmoidoscopy
Dr Christian von Wagner &Dr Lesley McGregor
Department of Behavioural Science and HealthUniversity College London
London, UK
UCL research teamRobert KerrisonHanna SkrobanskiBernardette BonelloStephen Morris
Honorary and external colleaguesWendy Atkin (Imperial College) John Isitt (Resonant Media)Sarah Marshall (St Mark’s Hospital)Andrew Prentice (St Mark’s Hospital)Colin Rees (South Tyneside NHS Trust)Hayley Miller (Gateshead Health NHS Trust)Lindy Berkman (Patient Representative)
The English NHS Bowel Cancer Screening Programme (BCSP)
Using Specialist Screening Practitioners (SSPs) to increase uptake of the new Bowel Scope Screening Programme: a feasibility study of patient navigation
Flexi-Quest: Predictors of bowel scope screening intentions and uptake
Use of a 12 month reminder with a theory-based leaflet to promote uptake of BSS at St. Mark’s Hospital: a three-arm RCT
• Average uptake is 43.1% (March 2013 to May 2014)
• Uptake varies across centres (36.8% to 52.0%)
• Uptake ranges from 32.7% (most deprived area) to 53.2% (least deprived area)
• Men (44.6%) are significantly more likely to attend than females (41.5%)
• Areas with a high level of ethnic diversity had significantly lower uptake (38.7%) than all other areas (41.2 to 47.3%)
Flexi-Quest: Uptake of Bowel Scope Screening
Pilots
March 2013 to
July 2013
6 Centres
Wave 1
Nov 2013 to
March 2014
16 (22) Centres
Wave 2
April 2014 to
March 2015
17 (39) Centres
Final Rollout
April 2015 to
December 2016
23 (62) Centres
Flexi-Quest: Barriers to Bowel Scope Screening
Study 1: Retrospective Questionnaire
Questionnaires sent = 3227Questionnaires returned = 1478 (45.8%)
Had attended BSS = 1138 (77.0%) Had not attended BSS = 260 (17.6%)
Missing = 80 (5.4 %)
Reason for non attendance (n = 260) N (%)
Worried the test would be painful 67 (25.8%)
Thought the test would be embarrassing 64 (24.6%)
Worried the test would cause harm to their bowel 53 (20.4%)
Didn’t believe they needed the test 53 (20.4%)
Difficult to make an appointment at a time that suited them 44 (16.9%)
Did not want to do the enema 38 (14.6%)
Never got round to it 27 (10.4%)
*Painful and embarrassing 41 (15.8%)
Thought the test would be embarrassing 64
Did not respond to invitation 35 (54.7%)
Cancelled appointment 27 (42.2%)
Confirmed but then DNA 2 (3.1%)
Unclear behaviour pathway 0 (0%)
Worried the test would be painful 67
Did not respond to invitation 34 (50.7%)
Cancelled appointment 26 (38.8%)
Confirmed but then DNA 6 (9.0%)
Unclear behaviour pathway 1 (1.5%)
Non attenders (n=260)
Did not respond to invitation
Cancelled their appointment
Confirm but then DNA
Unclear behaviour pathway
106 109 34 11
Flexi-Quest: Barriers to Bowel Scope Screening
Knowledge item N correct
Bowel scope screening helps prevent bowel cancer 151 (58.1%)
Did not respond to invitation (n = 101) 50 (49.5%)
Cancelled appointment (n = 107) 66 (61.7%)
Confirmed but then DNA 24 (15.9%)
Unclear behaviour pathway 11 (7.3%)
Attenders (n = 1131) 760 (67.2%)
Bowel scope screening is only useful for people with symptoms 196 (75.4%)
Did not respond to invitation (n = 104) 74 (37.8%)
Cancelled appointment (n = 107) 86 (43.9%)
Confirmed but then DNA 27 (13.8%)
Unclear behaviour pathway 9 (4.6%)
Attenders (n = 1132) 1065 (94.1%)
Flexi-Quest: knowledge questions
Non attenders (n=260)
Did not respond to invitation
Cancelled their appointment
Confirmed then DNA
Unclear behaviour pathway
106 109 34 11
Using Specialist Screening Practitioners (SSPs) to increase uptake of the new Bowel Scope Screening Programme: a feasibility study of patient navigation
Pre-invitation letter
Invitation letter
(with an appointment note and an information leaflet)
2 weeks
Confirmed
appointment
4 weeks
Attend
appointment
Do not attend their
appointment:
Cancellation letter sent
Confirmed
appointment
2 weeks to respond
Appointment cancelled:
Cancellation letter sent
2 weeks
No confirmation
Enema preparation
letter and leaflet
Reminder letter
(with an appointment note and an information leaflet)
2 weeks to respond
2 weeks
No confirmation
Patient
Navigation
Study InvitationParticipant Information Sheet,
consent form and non-participation postcard
Patient Navigation
Patient
Navigation
Patient Navigation: Results
• Between 18th May and 12th October, 1050 study packs sent out with BSS pre-invitation letters
• 152 people (14.5%) returned a study consent form and were randomised
• 16 (1.5%) returned a non-responder postcard
PN Groupn = 109
Control Groupn = 43
Totaln = 152
Appointment outcome n (%) n (%) n (%)
Confirmed and attended 87 (79.8) 34 (79.1) 121 (79.6)
Confirmed but did not attend 4 (3.7) 4 (9.3) 8 (7.2)
Did not confirm or attend 12 (11.0) 2 (4.7) 14 (8.6)
Appointment cancelled: a new booking to be arranged
4 (3.7) 3 (7.0) 7 (3.9)
Appointment cancelled: no new booking to be arranged
2 (0.9) 0 (0) 2 (0.7)
PN Outcome (n = 22) n (%)
No answer 10 (45.5)
Number not recognised 3 (13.6)
Wrong number (person not known) 1 (4.5)
Answered call but refused participation 1 (4.5)
Answered call, arranged a call back, and then refused participation
2 (9.1)
Answered call, spoke with SSP* 2 (9.1)
Lost in study 3 (13.6)
Patient Navigation: Results
*Only 1 was audio recorded and documented as delivery of PN
Patient Navigation: Results Summary
• PN intervention, as per our design, is not feasible within the current BSSP structure
• The programme structure and the regulations within that limit patient navigation as an intervention for non-responders (no phone numbers available)
• Non answered calls/false numbers: People within South Tyneside are “out to cause mischief”
• SSPs anxiety/reluctance to make calls to non-responders
• A funding bid has gone in to run a study to evaluate patient navigation through General Practice within Hull, UK (Yorkshire Cancer Research)
• Future work will continue to look at additional reminders and other communication strategies
Use of a 12 months reminder and theory-based leaflet to promote uptake of BSS at St. Mark’s Hospital: a three-arm RCT
• Reminder letter & leaflet designed in conjunction with Resonant, a social marketing company specialising in the development of health behaviour interventions.
• Initial designs informed by:
– Previous literature of reasons for non-participation
– Previous literature of effective intervention components
