The use of text messages as an alternative invitation method for breast cancer screening:A randomized controlled trial (M-TICS study)

This study aimed to determine whether a text message is as good as a postal letter as an invitation method for previous screenees in a breast cancer screening program, considering a non-inferiority margin of -2 percent points on participation rate. A non-inferiority randomized control trial was conducted. Women in the intervention group (n = 5,362) were invited by text message, and women in the control group (n = 5,482) were invited by letter, which is the standard invitation procedure of the program. In both groups, the invitation included a fixed appointment for mammography and a text message reminder 96 hours before the appointment. The primary outcome was screening participation rate (completing mammography within 12 weeks of invitation). Secondary outcomes included mammography attendance to initial or rescheduled appointments and cancellation rate. The intention-to-treat analysis showed a participation rate of 87.3% and 86.6% in the control and intervention groups, respectively. The difference in participation rate was -0.7 percentage points (95% confidence interval [CI], -1.8 to ∞), indicating non-inferiority of text messages compared to letter invitations. The per-protocol analysis showed similar results. Attendance at the initial appointment was higher in women who received the text message invitation compared to those in the control group (P<0.002). Women who received the invitation by letter canceled more the initial appointment scheduled compared to the text message group (21.1% and 15.1%, P<0.007). In conclusion, we found that a text message invitation for women who had previously participated in breast cancer screening was not inferior to the standard letter. This randomized controlled trial provides valuable insights into the use of alternative invitation methods for population-based cancer screening programs. However, further research is needed to determine the best timing and frequency of text messages for better outcomes and identify strategies for facilitating rescheduling or cancellation

The impact of interventions addressing socioeconomic inequalities in cancer-related outcomes in high-income countries: A systematic review

Background: High cancer mortality is a major source of burden. Population-wide programs have been developed to improve cancer outcomes, and although effective in improving outcomes overall, the socioeconomically disadvantaged population have disproportionately benefited. This systematic review evaluated interventions aimed at addressing inequalities in cancer-related outcomes between low and high socioeconomic groups within high-income countries.Materials and Methods: The Cochrane Register of Controlled Trials, EMBASE, and PubMed searches were completed in October 2018. Data extraction and quality appraisal were guided by established mechanisms. Impact of interventions, using odds ratios, with respective 95% confidence intervals were presented, where available.Results: Sixteen studies reporting on 19 interventions were included. Seven interventions (37%) reduced socioeconomic inequalities in cancer-related outcomes, focusing on participation in cancer screening. Interventions included pre-formulated implementation intentions; GP-endorsed screening invitations; enhanced reminder letters; text message reminders; and implementation of an organised screening program.Conclusions: This systematic review found limited evidence on the efficacy of existing interventions that aimed to reduce inequalities in cancer-related outcomes between people living in low and high socioeconomic areas among high-income countries. Future interventions should consider the specific needs of people living in socioeconomically disadvantaged areas to improve the efficacy of an intervention

Mass Matters: Increasing Mammography Rates to Underserved Women

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography rates to the underserved population by implementation of an intervention to increase breast cancer screening at a site dedicated to assist the economically challenged by sending an informational letter and text message reminder for one’s scheduled mammogram appointment. The Iowa Model of Evidence-Based Practice to Promote Quality Care was selected as a guideline to facilitate evidence into best practice to an underserved population serviced by several community health clinics in Northwest Indiana. Each participant received a mailed informational letter regarding the benefits of breast cancer screening and what a mammogram is. At the patient’s free will, she scheduled an appointment for a mammogram. Based on the date the mammogram scheduled, the participant received a text message reminder before the set appointment. Each appointment scheduled was detailed within the clinic’s EMR. The EMR was reviewed weekly of each appointment kept, rescheduled, cancelled, or no-show and documented within an Excel Spreadsheet. This data was categorized according to ethnic background, age, and insurance status to detail the crude rates of mammography. Data was analyzed utilizing the Chi square test of independence. Demographic information was calculated by descriptive statistics. A text message reminder was a statistically significant intervention to promote mammogram appointment adherence. Application of findings will be discussed

The use of behavioural sciences in targeted health messages to improve the participation in cervical and breast screening programmes

The aim of this thesis was to examine the effects of behaviourally informed interventions deployed in text message reminders and invitation letters on the participation in cervical and breast cancer screening. Cancer screening saves lives through detecting cancer or precancerous changes early, when medical intervention is more likely to reduce morbidity and mortality. A key factor in the success of any screening programme is public participation. Although some individuals may object to cancer screening, evidence suggests that public support for cancer screening provision in the UK is above 90%. Yet despite this, participation rates across all three cancer screening programmes (breast, cervical and colorectal) remain lower than expected given reported intentions. This thesis explores the role of decision making – both reflective and automatic in the context of cancer screening behaviour and highlights the potential for the application of behavioural economic theory and behavioural science to inform intervention design aimed at increasing cancer screening uptake. Through the application of frameworks informed by behaviour change theory, three randomised controlled trials were designed to test the impact of behavioural interventions on participation rates in regional cervical and breast cancer screening programmes within the London area. The intervention design of each trial focused on the message content within either text message reminders or invitation letters. The first randomised controlled trial (RCT) tested different behaviourally-informed invitation letters in cervical screening and found that a shortened letter that contained a loss framed message has a small but significant positive impact on cervical screening rates. The second RCT tested different text message reminder content against a no-text message control and found that text message reminders can improve participation in cervical cancer screening. However, the content of such text message reminders further affects screening participation behaviour. The final RCT tested the effect different behaviour message content in text message reminders for timed appointments in the breast screening programme. No significant difference in breast screening participation was noticed as a result of the message content within text message reminders. However, due to logistical barriers encountered during the trial, which included a reconfiguration of regional screening services, this study had to be closed early, prior to the sample size being reached and was therefore underpowered. This research highlights the importance of the message content within health communications in cancer screening to improve participation rates. Exploratory subgroup analyses within these trials, indicates that different subgroups of women with common characteristics such as age, level of deprivation or previous exposure to cancer screening affected which message content was most effective and improving cancer screening participation.Open Acces

Mass Matters: Increasing Mammography Rates to Underserved Women

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography rates to the underserved population by implementation of an intervention to increase breast cancer screening at a site dedicated to assist the economically challenged by sending an informational letter and text message reminder for one’s scheduled mammogram appointment. The Iowa Model of Evidence-Based Practice to Promote Quality Care was selected as a guideline to facilitate evidence into best practice to an underserved population serviced by several community health clinics in Northwest Indiana. Each participant received a mailed informational letter regarding the benefits of breast cancer screening and what a mammogram is. At the patient’s free will, she scheduled an appointment for a mammogram. Based on the date the mammogram scheduled, the participant received a text message reminder before the set appointment. Each appointment scheduled was detailed within the clinic’s EMR. The EMR was reviewed weekly of each appointment kept, rescheduled, cancelled, or no-show and documented within an Excel Spreadsheet. This data was categorized according to ethnic background, age, and insurance status to detail the crude rates of mammography. Data was analyzed utilizing the Chi square test of independence. Demographic information was calculated by descriptive statistics. A text message reminder was a statistically significant intervention to promote mammogram appointment adherence. Application of findings will be discussed

Text Messaging Appointment Reminders to Increase Patient Appointment Adherence within a Prevention and Wellness Program

Abstract Healthcare organizations want to provide quality care, decrease costs, and promote preventative services for the communities they service. Mobile health units have become an extension of many healthcare organizations and provide different types of services, such as mammography. Providing mammography and wellness exams on a mobile unit presents several challenges; appointment adherence is one of them. Mobile units typically travel to underserved areas to serve people at risk for various health conditions such as breast cancer. Breast cancer is estimated to affect over 250,000 women in the United States during 2017; women have a 1:8 lifetime risk of being diagnosed withbreast cancer (American Cancer Society, 2017). Text messaging (SMS) is a new technology that can be used to aid healthcare organizations in increasing their attendance rate to appointments. With 95% of Americans owning a cell phone and 73% of them engaging in text activity, it was hypothesized that text message appointment reminders would increase appointment adherence (Pew Research Center, 2011). A pilot study was implemented in a Prevention and Wellness department that provides mammogram screenings and wellness exams on a mobile unit. Implementation of text message appointment reminders was conducted for one month. Retrospective analysis of the data was conducted during the one month period. In total, 240 women attended their screening appointment. The non-attendance appointment rate for the intervention cohort group was 4.94%; the nonattendance rate for the customary method cohort group was 6.43%. There was a 23% reduction in non-attendance rate after the implementation of text message reminders. Keywords: text messaging, appointment adherence, mammogram, mobile uni

Effectiveness and acceptability of targeted text message reminders in colorectal cancer screening:a randomised controlled trial (M-TICS study)

Background:Mobile phone text message reminders to increase colorectal cancer (CRC) screening participation have shown moderate effects.Objective:This study assessed effectiveness and acceptability of targeted text message reminders for those who picked up but did not return their screening kit at pharmacy within 14 days in a CRC screening program in Catalonia, SpainMethods:We performed a randomised control trial in the screening hub of the metropolitan area of Barcelona that covers 502,348 adults aged 50-69 years. In total, 9,369 individuals were randomised in a 1:1 ratio to receive either a text message reminder or no reminder. Main primary outcome was FIT completion rate within 126 days from FIT kit pick-up (intention-to-treat-analysis). A telephone survey assessed acceptability and appropriateness of the intervention. Cost-effectiveness of adding a text message reminder to FIT completion was also performed.Results:FIT completion rate was 77.7% in control arm and 82.6% in text message arm. Higher participation rates in intervention arm were reported independent of sex, age, socioeconomic level, and screening profiles. 89.2% of interviewees considered it important and useful to receive text message reminders to FIT completion, and 93.4% preferred text messages to postal letters.Conclusions:Adding text message reminders to the standard procedure significantly increased FIT kit return rates and was considered acceptable and appropriate. The SMS plus letter reminder to complete and return the FIT kit was a cost-effective strategy. Clinical Trial: Registration Number NCT04343950 (04/09/2020) at clinicaltrials.go

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

Objective: To quantify the effect of strategies to improve retention in randomised trials.<p></p> Design: Systematic review and meta-analysis.<p></p> Data sources Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units.<p></p> Review: methods Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy.<p></p> Results: 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04).<p></p> Conclusions: Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.<p></p&gt

Reducing the No-show Rate of Breast Cancer Screenings: A Quality Improvement Project

Clinical nurse leaders (CNLs) are change agents who “improve quality, cost, or efficiency of healthcare delivery” (Noles, Barber, James, & Wingo, 2019, p. 307). The CNL of a breast cancer clinic recognized the significant impact the high no-show rate of breast cancer screening appointments had on patient outcomes and staff productivity. After conducting a microsystem assessment, the CNL organized a meeting with key stakeholders to identify potential interventions to address this issue. Concerns regarding the efficiency and effectiveness of the current telephone reminder system were raised, indicating an area for improvement. The CNL facilitated the team in researching evidence-based practices to identify a better method to remind patients of their appointments. After conducting the literature review, a text-based reminder system proved to be the most effective, efficient, and economical (Vidal, Garcia, Benito, Binefa, & Moreno, 2014). The aim of this quality improvement project is to reduce the breast cancer screening no-show rate by 2% to enhance the quality of life of patients, decreasing cancer mortality through early detection of breast cancer. During this time, the Covid-19 pandemic hit, preventing the progression and changing the scope of the project where implementation and evaluation of the intervention could not be accomplished. However, the CNL continued communicating and collaborating with staff members remotely to develop a detailed plan with the hopes of the team utilizing components that will work for them. The CNL was driven by professional values and core competencies to engage staff, cultivating an environment that supports change

Can Digital Nudging Get More Women to Participate in Cervical Screening?

Cervical screening can radically reduce the incidence of cervical cancer. It is one of the few cancers that can be prevented due to screening. The Cervical Screening Program in Norway, therefore, recommends all women between the ages of 25-69 to participate in screening. Yet, approximately 250,000 women have not done so in the last ten years. This study explores whether digital nudging can get more women to participate in cervical screening. Based on theory from persuasive technology and dig- ital nudging five persuasive messages were designed. These messages were presented to a representative sample for cervical screening through a survey to investigate how they were perceived. A total of 280 responses were solicited. Findings show that dig- ital nudging in the form of persuasive messages can be effective to get more women to participate in cervical screening. However, some messages were more effective than others. The text message with the highest potential to get women to participate in screening, of those who were tested, was a message with a scheduled appointment. 87% of all the respondents answered that it is desirable to receive an invitation to cer- vical screening through a text message