Imperial College London
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Professor Amanda Cross

Faculty of Medicine, School of Public Health

Professor of Cancer Epidemiology
 
 
 
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Contact

 

+44 (0)20 7594 3338amanda.cross

 
 
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Assistant

 

Mr Will Kay +44 (0)20 7594 3350

 
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Location

 

Room 1089Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Cross:2021:10.1177/0969141321997480,
author = {Cross, AJ and Myles, J and Greliak, P and Hackshaw, A and Halloran, S and Benton, SC and Addison, C and Chapman, C and Djedovic, N and Smith, S and Wagner, CV and Duffy, SW and Raine, R},
doi = {10.1177/0969141321997480},
journal = {Journal of Medical Screening},
pages = {419--425},
title = {Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial},
url = {http://dx.doi.org/10.1177/0969141321997480},
volume = {28},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVES: To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme. METHODS: The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation. RESULTS: Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result. CONCLUSIONS: General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.
AU  - Cross,AJ
AU  - Myles,J
AU  - Greliak,P
AU  - Hackshaw,A
AU  - Halloran,S
AU  - Benton,SC
AU  - Addison,C
AU  - Chapman,C
AU  - Djedovic,N
AU  - Smith,S
AU  - Wagner,CV
AU  - Duffy,SW
AU  - Raine,R
DO  - 10.1177/0969141321997480
EP  - 425
PY  - 2021///
SN  - 0969-1413
SP  - 419
TI  - Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial
T2  - Journal of Medical Screening
UR  - http://dx.doi.org/10.1177/0969141321997480
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33645308
UR  - https://journals.sagepub.com/doi/10.1177/0969141321997480
UR  - http://hdl.handle.net/10044/1/87400
VL  - 28
ER  -
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