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dc.contributor.authorChapman, Caroline J
dc.date.accessioned2023-01-23T11:18:40Z
dc.date.available2023-01-23T11:18:40Z
dc.date.issued2021
dc.identifier.citationCross, A.J., Myles, J., Greliak, P., Hackshaw, A., Halloran, S., Benton, S.C., Addison, C., Chapman, C., Djedovic, N., Smith, S., Wagner, C.v., Duffy, S.W. and Raine, R. (2021) 'Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial', Journal of Medical Screening, 28(4), pp. 419-425. doi: 10.1177/0969141321997480.en_US
dc.identifier.issn1475-5793
dc.identifier.urihttp://hdl.handle.net/20.500.12904/16098
dc.description.abstractOBJECTIVES: To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme., METHODS: The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation., RESULTS: Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result., CONCLUSIONS: General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.
dc.description.urihttps://dx.doi.org/10.1177/0969141321997480en_US
dc.language.isoenen_US
dc.publisherSageen_US
dc.subjectColorectal neoplasmsen_US
dc.subjectGeneral practiceen_US
dc.titleIncluding a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trialen_US
dc.typeArticleen_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
rioxxterms.versionVoRen_US
rioxxterms.versionofrecord10.1177/0969141321997480en_US
rioxxterms.typeJournal Article/Reviewen_US
refterms.dateFCD2023-01-23T11:18:41Z
refterms.versionFCDVoR
refterms.dateFOA2023-01-23T11:18:41Z
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2021
html.description.abstractOBJECTIVES: To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme., METHODS: The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation., RESULTS: Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result., CONCLUSIONS: General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.en_US
rioxxterms.funder.project94a427429a5bcfef7dd04c33360d80cden_US


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