title: Anticipated regret to increase uptake of colorectal cancer screening (ARTICS): A randomised controlled trial.
abstract: Screening is important for early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase uptake of colorectal cancer screening. A randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters, was conducted. A total of 60,000 adults aged 50-74 years from the Scottish National Screening programme were randomised into the following groups: (1) no questionnaire (control), (2) Health Locus of Control questionnaire (HLOC) or (3) HLOC plus AR questionnaire. The primary outcome was return of the guaiac faecal occult blood test (FOBT). The secondary outcomes included intention to return test kit and perceived disgust (ICK). A total of 59,366 people were analysed as allocated (intention-to-treat (ITT)); no overall differences were seen between the treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). In total, 13,645 (34.2%) individuals returned the questionnaires. Analysis of the secondary questionnaire measures showed that AR indirectly affected FOBT uptake via intention, whilst ICK directly affected FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less-than-strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). The findings show that psychological concepts including AR and perceived disgust (ICK) are important factors in determining FOBT uptake. However, the AR intervention had no simple effect in the ITT analysis. It can be concluded that, in those with low intentions, exposure to AR may be required to increase FOBT uptake. The current controlled trials are presented at the website www.controlled-trials.com (number: ISRCTN74986452).
authors: Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, Scotland, UK. Electronic address: reo1@stir.ac.uk.
authors: Ronan E
authors: RE
authors: O'Carroll
authors: Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, Scotland, UK. Electronic address: jac2@stir.ac.uk.
authors: Julie A
authors: JA
authors: Chambers
authors: Scottish Bowel Screening Centre, Kings Cross, Clepington Road, Dundee, DD3 8EA, Scotland, UK. Electronic address: linda.brownlee@nhs.net.
authors: Linda
authors: L
authors: Brownlee
authors: Scottish Bowel Screening Centre, Kings Cross, Clepington Road, Dundee, DD3 8EA, Scotland, UK. Electronic address: g.libby@dundee.ac.uk.
authors: Gillian
authors: G
authors: Libby
authors: Surgery and Molecular Oncology, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK. Electronic address: r.j.c.steele@dundee.ac.uk.
authors: Robert J C
authors: RJ
authors: Steele
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000523:psychology* / Q000706:statistics & numerical data; D004644:Emotions; D005260:Female; D015438:Health Behavior; D006801:Humans; D033182:Intention; D008297:Male; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D011795:Surveys and Questionnaires
keywords: Anticipated regret; Colorectal cancer; Disgust; Faecal occult blood test; Screening