Trialling suggested deadlines on bowel screening invitations to increase participation

Lead researcher: Professor Mark Lawler and Dr Ethna McFerran 

Location: Queen’s University Belfast 

Grant award: £24,727 

Professor Lawler and Dr McFerran tested if adding a deadline to the letter sent out with the bowel screening kit can increase participation in screening programmes.

The challenge 

Bowel cancer screening saves lives, as it can detect bowel cancers at an earlier stage when treatment is more effective. It can also find precancerous polyps that can then be removed before they ever develop into a cancer.

It’s therefore important that everyone eligible for screening takes part when invited. However, although most people say they want to do their screening test, fewer than 7 in 10 follow through and complete it. Screening uptake is also lower in areas with higher deprivation.

The science behind the project 

Professor Lawler and Dr McFerran’s team trialled the impact of adding suggested deadlines for completion to screening invitation letters. 

They compared response rates between people who got the version of the letter with a three-week deadline, and people who got the standard letter. All participants were “never-responders,” meaning they’d been invited for screening before but hadn’t taken part. 

The study was carried out in Northern Ireland, which persistently has the lowest bowel screening uptake compared to the other UK nations. It focused on the areas of Northern Ireland with the highest deprivation.

Results

Adding the deadline didn’t increase the overall number of people who returned their screening kits — responses among the deadline group were very similar to the standard letter group.

However, among the people who did respond, those who received the deadline letter returned their kit faster (11 days compared to 22 days). But this didn’t translate to more people taking part overall.

What difference will this project make? 

We always want new approaches to improve screening uptake, so more people with bowel cancer can be diagnosed at the earliest stages.

A similar trial carried out in Scotland has found that adding a deadline to the screening invitation letter does improve uptake. However, this study was looking across the whole population, without a focus on deprivation.

This project has shown that deadlines aren’t enough on their own to overcome the bigger barriers faced by people in the most deprived areas. If deadlines are implemented across the screening programme, more monitoring is needed to make sure this doesn’t widen inequalities.

The research team are now working with screening services to begin exploring other ways to design future invitations to better reach under-screened communities, and address those deeper barriers.

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