title: Optimising colorectal cancer screening acceptance: a review.
abstract: The study aims to review available evidence concerning effective interventions to increase colorectal cancer (CRC) screening acceptance. We performed a literature search of randomised trials designed to increase individuals' use of CRC screening on PubMed, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. Small (≤ 100 subjects per arm) studies and those reporting results of interventions implemented before publication of the large faecal occult blood test trials were excluded. Interventions were categorised following the Continuum of Cancer Care and the PRECEDE-PROCEED models and studies were grouped by screening model (opportunistic vs organised). Multifactor interventions targeting multiple levels of care and considering factors outside the individual clinician control, represent the most effective strategy to enhance CRC screening acceptance. Removing financial barriers, implementing methods allowing a systematic contact of the whole target population, using personal invitation letters, preferably signed by the reference care provider, and reminders mailed to all non-attendees are highly effective in enhancing CRC screening acceptance. Physician reminders may support the diffusion of screening, but they can be effective only for individuals who have access to and make use of healthcare services. Educational interventions for patients and providers are effective, but the implementation of organisational measures may be necessary to favour their impact. Available evidence indicates that organised programmes allow to achieve an extensive coverage and to enhance equity of access, while maximising the health impact of screening. They provide at the same time an infrastructure allowing to achieve a more favourable cost-effectiveness profile of potentially effective strategies, which would not be sustainable in opportunistic settings.
authors.affiliation: Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.affiliation: Digestive Disease Center, University of Washington, Seattle, Washington, USA.
authors.forename: John
authors.initials: J
authors.lastname: Inadomi
authors.affiliation: Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.affiliation: Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bellisario
authors.affiliation: Unit of Gastroenterology, Ospedale Nuovo Regina Margherita, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
mesh_terms: D015179:Colorectal Neoplasms / Q000517:prevention & control*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D010342:Patient Acceptance of Health Care
keywords: COLORECTAL CANCER SCREENING; COST-EFFECTIVENESS