title: An advance notification letter increases participation in colorectal cancer screening.
abstract: OBJECTIVE
  To determine the impact of novel invitation strategies on population participation in faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening.
  
  
  METHODS
  A community screening programme in Adelaide, South Australia.
  
  
  METHODS
  In total, 2400 people aged 50-74 years were randomly allocated to one of four CRC screening invitation strategies: (a)
  
  
  METHODS
  standard invitation-to-screen letter explaining risk of CRC and the concept, value and method of screening; (b) Risk: invitation with additional messages related to CRC risk; (c) Advocacy: invitation with additional messages related to advocacy for screening from previous screening programme participants and (d) Advance Notification: first, a letter introducing CONTROL letter messages followed by the standard invitation-to-screen. Invitations included an FIT kit. Programme participation rates were determined for each strategy relative to control. Associations between participation and sociodemographic variables were explored.
  
  
  RESULTS
  At 12 weeks after invitation, participation was:
  
  
  METHODS
  237/600 (39.5%); Risk: 242/600 (40.3%); Advocacy: 216/600 (36.0%) and Advance Notification: 290/600 (48.3%). Participation was significantly greater than CONTROL only in the Advance Notification group (Relative risk [RR] 1.23, 95% confidence interval [CI] 1.06-1.43). This effect was apparent as early as two weeks from date of offer; Advance Notification: 151/600 (25.2%) versus
  
  
  METHODS
  109/600 (18.2%, RR 1.38, 95% CI 1.11-1.73).
  
  
  CONCLUSIONS
  Advance notification significantly increased screening participation. The effect may be due to a population shift in readiness to undertake screening, and is consistent with the Transtheoretical Model of behaviour change. Risk or lay advocacy strategies did not improve screening participation. Organized screening programmes should consider using advance notification letters to improve programme participation.
authors.affiliation: Bowel Health Service, Repatriation General Hospital Daw Park, Daw Park, South Australia 5041, Australia. scoles@rgh.sa.gov.au
authors.forename: S R
authors.initials: SR
authors.lastname: Cole
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Wilson
authors.forename: D
authors.initials: D
authors.lastname: Turnbull
authors.forename: A
authors.initials: A
authors.lastname: Esterman
authors.forename: G P
authors.initials: GP
authors.lastname: Young
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D013021:South Australia; D013997:Time Factors