title: Using physician-linked mailed invitations in an organised colorectal cancer screening programme: effectiveness and factors associated with response.
abstract: OBJECTIVE
  A central tenet of organised cancer screening is that all persons in a target population are invited. The aims of this study were to identify participant and physician factors associated with response to mailed physician-linked invitations (study 1) and to evaluate their effectiveness in an organised colorectal cancer (CRC) screening programme (study 2).
  
  
  METHODS
  2 studies (study 1-cohort design and study 2-matched cohort design, comprising study 1 participants and a matched control group) were conducted in the context of Ontario's organised province-wide CRC screening programme.
  
  
  METHODS
  102 family physicians and 11 302 associated eligible patients from a technical evaluation ('the Pilot') of large-scale mailed invitations for CRC screening were included. Matched controls were randomly selected using propensity scores from among eligible patients associated with family physicians in similar practice types as the Pilot physicians.
  
  
  METHODS
  Physician-linked mailed invitation to have CRC screening.
  
  
  RESULTS
  Uptake of faecal occult blood test (FOBT) within 6 months of mailed invitation (primary) and uptake of FOBT or colonoscopy within 6 months of mailed invitation (secondary).
  
  
  RESULTS
  Factors significantly associated with uptake of FOBT included prior FOBT use, older participant age, greater participant comorbidity and having a female physician. In the matched analysis, Pilot participants were more likely to complete an FOBT (22% vs 8%, p<0.0001) or an FOBT or colonoscopy (25% vs 11%, p<0.0001) within 6 months of mailed invitation than matched controls. The number needed to invite to screen one additional person was 7.
  
  
  CONCLUSIONS
  Centralised large-scale mailing of physician-linked invitations is feasible and effective in the context of organised CRC screening.
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Tinmouth
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Paszat
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.forename: Lingsong
authors.initials: L
authors.lastname: Yun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D009864:Ontario; D011177:Postal Service
keywords: Preventive Medicine; Primary Care; Public Health