Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.

Abstract

Background: Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice screening program, but uptake is low (43.5%). Increasing participation will reduce morbidity and mortality associated with CRC. Endorsement by general practitioners is strongly associated with increasing screening uptake. Aim: SMARTscreen aimed to test the efficacy of sending a multi-intervention SMS from general practice to 50-60-year-old patients due to receive the NBCSP kit on NBCSP uptake compared to “usual care”. Design and Setting: A stratified cluster randomised controlled trial involving 21 Australian general practices in Western Victoria, Australia. Methods: For intervention practices, patients due to receive the NBCSP kit within the 6-month intervention period were sent an SMS just prior to receiving their NBCSP kit. The SMS included a personalised message from the patient’s general practice endorsing the NBCSP kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care (opportunistic screening). The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12-months from randomisation, estimated using generalised linear model regression. Results: Thirty-nine percent (1143/2537) of patients in 11 intervention practices and 23% (583/2914) of patients in 10 control practices had a FIT result in the electronic health records, a 16.5% increase (95% confidence internal:2.02-30.9%). Conclusion: The SMS increased NBCSP kit return in 50-to-60-year-old general practice patients. This finding informed a larger trial –SMARTERscreen– to test this intervention in a broader Australian population.