Larsen MB, Hedelund M, Flander L, et al. The impact of pre-notifications and reminders on participation in colorectal cancer screening - A randomised controlled trial. Prev Med. 2022 Nov;164:107229. doi: 10.1016/j.ypmed.2022.107229. Epub 2022 Aug 31. (Original study)

This study aimed to test whether participation in colorectal cancer (CRC) screening can be increased by combining the standard invitation procedure with a pre-notification and/or an extra reminder. In a non-blinded randomised controlled trial nested in a population-based CRC screening programme employing the faecal immunochemical test, Group I received a three-staged invitation procedure (pre-notification, invitation and one reminder), Group II received a three-staged invitation procedure (invitation and two reminders) and Group III received a four-staged invitation procedure (pre-notification, invitation and two reminders). The control group received the invitation and one reminder (usual procedure). A total of 59,041 participants were included in the analyses. Overall participation rates increased from 66.9% in the control group to 69.8% in the four-staged invitation procedure corresponding to an increase in overall participation rate of 2.9% (95% CI: 1.8 to 4.0). In the age group 50-59 years, the four-staged invitation procedure increased the participation rate by 4.0% (95% CI: 2.4 to 5.6). An extra reminder increased participation with 2.7% (95% CI: 1.1; 4.2) for males compared to 1.1% (95% CI: -0.3; 2.5) for females. In conclusion, the four-staged invitation procedure was the most effective invitation procedure indicating that multiple invitation procedures are most effective, especially in the youngest age group. If a three-staged invitation procedure is applied, a second reminder should be preferred over a pre-notification. Trial registration The project was registered at on 26 February 2020 and patient enrolment began in August 2020. Identifier: NCT04292366.

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Comments from MORE raters

Physician rater

One is left wondering if 6 reminders might increase the uptake by another 1%. This study is suggesting changes in practice that are becoming less and less likely to be affordable and implementable.

Physician rater

The effect of various screening procedures may be influenced by the reminders of the availability and advisability of such procedures. Timing and wording of reminders are likely significant. This is an important topic. Finding the right wording and the right timing of (the ideal number of) reminders might lead to increased screening for conditions for which intervention might decrease morbidity and mortality, for little additional cost.

Physician rater

This is a good trial indicating that proper reminders, periodically, can increase the number of people getting screened for a common cancer.
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