1. CRC Screening invitation is sent
Text-message Reminders In Colorectal Cancer Screening (TRICCS): A Non-clinical Randomised Controlled Trial
Yasemin Hirst1, Hanna Skrobanski1, Robert Kerrison1, Lindsay C Kobayashi2, Nicholas Counsell3, Natasha Djedovic4, Josephine Ruwende5, Mark Stewart4, Christian von Wagner1
1 Health Behaviour Research Centre, UCL, London, UK 2 Harward T. H. Chan School of Public Health , Cambridge, US, 3 UCL Cancer Trials Centre, UCL, London, UK
4 London North West Healthcare NHS Trust, London,UK 5 NHS England London Region, London, UK
Methods
CRC Screening invitation is sent
[Usual Care]
N=8269
Background
Results
Colorectal Cancer (CRC) 4th most common cancer in the UK.
In England, adults aged 60–74 years are eligible for colorectal cancer screening using a guaiac faecal occult blood test (gFOBt) kit
Screening uptake at first time invitation is 54% (von Wagner et al., 2011)
Multi-component reminders are effective to improve CRC uptake (usual care: 37% vs postal + phone + text reminder: 82%, Baker et al., 2014)
Text-messages are often considered to be the next best alternative to telephone reminders, as they have the advantage of providing instant and direct transmission at a low cost
Intention-to-treat: Uptake did not differ significantly between groups for the whole population of older adults (odds ratio [OR] 1·03, 95% confidence interval [CI] 0·94–1·12; p=0·56), but did vary between groups for first-time invitees (uptake was 35% in the control and 41% in the intervention; OR 1·29, 95% CI 1·04–1·58; p=0·02).
WEEK 1
OR=1.29 CI ( ), p=0.02
OR=0. 98 CI ( ) p=0.66
gFOBt kit dispatched
[Usual Care]
Aims
The primary aim of this RCT was to test the effectiveness of a text-message reminder to increase gFOBt uptake.
Secondary aims were to examine between group differences for first-time invitees and to establish the efficacy of the text-message reminder to increase gFOBt uptake on a per-protocol basis (limited to individuals who have not returned their kit within 8 weeks and had a registered mobile number on their GPs Clinical System)
Methods
WEEK 5
Table 2. Mobile phone coverage among 141 GPs
(Both study groups included)
% (N)
OR (95% CI)
p-value
 Total
49.4 (N=4089)
Gender
Female
48.4 (n=2079)
Ref
Male
50.6 (n=2010)
1.08 ( )
.09
Age
60-64
53.6 (n=1972)
<.001
65-69
49.2 (n=1213)
.85 ( )
.004
70-74
42.6 (n=904)
.67 ( )
IMD
Quintile 1
42.7 (n=301)
Quintile 2
40.7 (n=471)
1.24 ( )
0.04
Quintile 3
50.2 (n=1026)
1.61 ( )
Quintile 4
51.7 (n=1316)
1.62 ( )
Quintile 5
53.3 (n=920)
1.67 ( )
CCG
Croydon
61.9 (n=1109)
Greenwich
56.1 (n=960)
.79 ( )
.001
Hammersmith &Fulham
32.2 (n=186)
.29 ( )
Hounslow
36.2 (n=595)
.35 ( )
Lewisham
58.1 (n=784)
.81 ( )
.007
West London
38.1 (n=455)
.38 ( )
We performed a randomised controlled trial across 141 general practices in London.
Screening-eligible adults (n=8269) were randomised in a 1:1 ratio to receive either a text-message reminder [INTERVENTION] or no text-message reminder [CONTROL] if they had not returned their faecal occult blood test kit within eight weeks of initial invitation. (Hirst et al., 2016)
The primary outcome was the proportion of adults returning a test kit at the end of an 18-week screening episode.
The data were analysed on an intention-to-treat basis using logistic regression. A subgroup analysis was conducted for individuals receiving an invitation for the first time.
Reminder Letter
[Usual Care]
Randomisation
(1:1) n=8269
Control
[Usual Care]
(n=4135)
Intervention
[Text-reminder] (n=4134)
WEEK 8
Results
Table 1. Sample Characteristics
 % (N)
Uptake (%)
Total
100.0 (n=8269)
40.0
 Gender
Male
48.0 (n=3973)
42.8
Female
52.0 (n=4296)
37.4
Age
60-64
44.5 (n=3682)
38.2
65-69
29.8 (n=2466)
40.9
70-74
25.7 (n=2121)
 IMD (Index of Multiple Deprivation)
Quintile 1
(Least Deprived)
8.6 (n=705)
51.5
Quintile 2
14.1 (n=1157)
41.9
Quintile 3
25.0 (n=2044)
43.4
Quintile 4
31.1 (n=2544)
38.0
Quintile 5
(Most Deprived)
21.1 (n=1727)
34.0
CCG (Clinical Commissioning Group)
Croydon
21.7 (n=1791)
47.1
Greenwich
20.7 (n=1712)
43.3
Hammersmith &Fulham
7.0 (n=577)
35.9
Hounslow
19.9 (n=1645)
40.1
Lewisham
16.3 (n=1349)
37.5
West London
14.5 (n=1195)
30.5
Invitation Status
First-time invitees
18.6 (n=1542)
Repeat invitees
81.4 (n=6727)
40.8
Among 1393 people in the intervention group with a registered mobile and no returned kit, 73.4 % (n=1023) successfully received their reminders on the eighth week of their screening episode.
The successful delivery of text-messages did not differentiate by participating CCGs (p=0.08), age group (p=0.09), gender (p=0.45), or IMD quintile (p=0.41) and invitation status (p=0.07).
Eligible for a text-reminder
n=1393 Received text-reminder
n=1023 Undelivered messages
n=370
Conclusion
Although text-message reminders did not significantly increase uptake of the overall population, the improvement among first-time invitees is encouraging.
40%
(1648 / 4135)
41%
(1674 / 4134)
WEEK 18
Intention to treat: [OR] 1·03, 95% [CI] 0·94–1·12; p=0·56
References
Baker DW, Brown T, Buchanan DR, Weil J, Balsley K, Ranalli L, Lee JY, Cameron KA, Ferreira MR, Stephens Q, Goldman SN (2014) Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA intern Med 174(8):
Hirst, Y., Kerrison, R., Kobayashi, L. C., Counsell, N., Djedovic, N., Ruwende, J., … von Wagner, C. (2016). Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial. BMC Public Health, 16(1), 74.
von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, Obichere A, Handley G, Logan RF, Rainbow S, Smith S, Halloran S, Wardle J (2011) Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol 40(3):