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Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening

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Title: Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening
Authors: Raine, R
Duffy, SW
Wardle, J
Solmi, F
Morris, S
Howe, R
Kralj-Hans, I
Snowball, J
Counsell, N
Moss, S
Hackshaw, A
Von Wagner, C
Vart, G
McGregor, L
Smith, SG
Halloran, S
Handley, G
Logan, RF
Rainbow, S
Smith, S
Thomas, MC
Atkin, W
Item Type: Journal Article
Abstract: background: There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual’s general practice (GP endorsement; GPE) reduced this gradient. methods: A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. results: We enrolled 265 434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04–1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78 000). conclusions: Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP.
Issue Date: 7-Jan-2016
Date of Acceptance: 24-Oct-2015
URI: http://hdl.handle.net/10044/1/40682
DOI: http://dx.doi.org/10.1038/bjc.2015.413
ISSN: 1532-1827
Publisher: Cancer Research UK
Start Page: 321
End Page: 326
Journal / Book Title: British Journal of Cancer
Volume: 114
Issue: 3
Copyright Statement: 12 months after the publication date, this work will become freely available under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License.
Sponsor/Funder: University College London Hospitals NHS Foundation
Cancer Research UK
Funder's Grant Number: Programme G526
C8171/A16894
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
socioeconomic inequalities
colorectal cancer screening
general practice
endorsement
cluster-randomised trial
PRIMARY-CARE PRACTITIONER
OCCULT BLOOD-TEST
COLORECTAL-CANCER
PARTICIPATION
PROGRAM
TRIAL
Adenoma
Aged
Attitude of Health Personnel
Carcinoma
Colonoscopy
Colorectal Neoplasms
Communication
Early Detection of Cancer
England
Female
General Practice
Healthcare Disparities
Humans
Male
Middle Aged
Occult Blood
Patient Compliance
Physician-Patient Relations
Social Class
Socioeconomic Factors
State Medicine
Oncology & Carcinogenesis
1112 Oncology And Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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