Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake

ABSTRACT

Colorectal cancer (CRC) represents a global public health concern. CRC screening is associated with significant reductions in CRC incidence and mortality, however, uptake is suboptimal. This systematic review and meta-analysis of randomised controlled trials explored the effectiveness of interventions designed to increase screening uptake, plus the impact of various moderators. Data from 102 studies including 1.94 million participants were analysed. Results showed significant benefit of all interventions combined (OR, 1.49, 95% CI: 1.43, 1.56, p < 0.001). The effects were similar in studies using objective versus self-reported uptake measures and lower in studies judged to be at high risk of bias. Moderator analyses indicated significant effects for aspects of behaviour (effects lower for studies on non-endoscopic procedures), and intervention (effects higher for studies conducted in community settings, in healthcare systems that are not free, and that use reminders, health-professional providers, paper materials supplemented with in-person or phone contact, but avoid remote contact). Interventions that included behaviour change techniques targeting social support (unspecified or practical), instructions or demonstration of the behaviour, and that added objects to the environment produced stronger effects. The way in which findings can inform interventions to improve CRC screening uptake is discussed.

KEYWORDS:

• Meta-analysis
• colorectal cancer
• screening uptake
• health interventions
• behaviour change techniques

Acknowledgements

This research was support by two grants: (1) Increasing uptake of bowel cancer screening in Leeds (a PhD studentship to AT supported by University of Leeds and Leeds City Council); (2) Increasing bowel cancer screening uptake: Development and testing of a new behaviour change intervention for use in deprived and non-deprived populations (Yorkshire Cancer Research; Award Reference: L397). The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. All available data can be obtained by contacting the corresponding author or by downloading from: https://osf.io/kx48 g/?view_only=2e78a039727f4cec92302121a3927b92; the authors will retain exclusive use until the publication of major outputs. The authors of this article affirm that the manuscript is an honest, accurate, and transparent account of the study being reported and that no important aspects of the study have been omitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Thirty articles included several treatment arms and a single control arm. Each comparison of a treatment arm to a control arm was referred to here as a ‘study comparison’.