In a Scottish study (TEMPO) reported in The Lancet, Robb et al found that a behavioral intervention adding a deadline for fecal immunochemical testing (FIT) return in the invitation letter to FIT colorectal cancer screening resulted in superior uptake of testing.
Study Details
In the trial, 40,000 consecutive adults (aged 50–74 years) eligible for colorectal cancer screening were randomly assigned in June and July 2023 to one of eight groups: (1) standard invitation (control group—no deadline, no planning tool); (2) 1-week suggested FIT return deadline; (3) 2-week deadline; (4) 4-week deadline; (5) problem-solving planning tool (no deadline); (6) planning tool plus 1-week deadline; (7) planning tool plus 2-week deadline; or (8) planning tool plus 4-week deadline. The primary outcome measure was the proportion of completed FITs returned for testing by a colorectal cancer screening laboratory to within 3 months of FITs invitations being mailed to eligible individuals.
Key Findings
The control group had a 3-month FIT return rate of 66.0%. The highest return rate was found in the group with a 2-week deadline without the planning tool (68.0%; difference vs control = 2.0%, 95% confidence interval [CI] = 0.2%–3.9%). The poorest return rate was observed among individuals who received a planning tool without a deadline (63.2%; difference vs control = –2.8%, 95% CI = –4.7% to –0.8%).
In analysis to determine the relative effects of deadline and planning tool on FIT return rate, a significant effect of providing a deadline was observed (adjusted odds ratio [OR] = 1.13, 95% CI = 1.08–1.19, P < .0001), whereas no effect of providing a planning tool was observed (adjusted OR = 0.98, 95% CI = 0.94–1.02, P = .34). A significant interaction was observed between the deadline and planning tool interventions: among individual given a deadline, there was no evidence of an effect of receiving a planning tool (adjusted OR = 1.02, 95% CI = 0.97–1.07, P = .53); in the absence of a deadline, receipt of the planning tool was detrimental to return rate (adjusted OR = 0.88, 95% CI = 0.81–0.96, P = .0030).
In the absence of the planning tool, there was little evidence that use of a deadline had any effect on return rates at 3 months. However, secondary analyses indicated that the use of deadlines was associated with higher earlier return rates (within 1, 2, and 4 weeks, particularly around the time of the deadline), and reduced the need to issue a reminder letter after 6 weeks; no evidence that the planning tool had a positive impact was observed, and no evidence of interactions between interventions was observed.
The investigators concluded: “Adding a single sentence suggesting a deadline for FIT return in the invitation letter to FIT colorectal screening resulted in more timely FIT return and reduced the need to issue reminder letters. This is a highly cost-effective intervention that could be easily implemented in routine practice. A planning tool had no positive effect on FIT return.”
Kathryn A. Robb, PhD, of University of Glasgow, Glasgow, is the corresponding author for The Lancet article.
Disclosure: The study was funded by the Scottish Government and Cancer Research UK. For full disclosures of all study authors, visit thelancet.com.
