McIntosh JG, Jenkins M, Wood A, et al. Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial. Br J Gen Pract. 2024 Mar 27;74(741):e275-e282. doi: 10.3399/BJGP.2023.0230. Print 2024 Apr. (Original study)

BACKGROUND: Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice, organised screening programme, but uptake is low (40.9%) and increasing participation could reduce morbidity and mortality associated with CRC. Endorsement by GPs is strongly associated with increasing screening uptake.

AIM: This study (SMARTscreen) aimed to test whether a multi-intervention short message service (SMS) sent by general practices to 50-60-year-old patients who were due to receive the NBCSP kit would increase NBCSP uptake, by comparing it with usual care.

DESIGN AND SETTING: A stratified cluster randomised controlled trial was undertaken, involving 21 Australian general practices in Western Victoria, Australia.

METHOD: For intervention practices, people due to receive the NBCSP kit within a 6-month study period were sent an SMS just before receiving the kit. The SMS included a personalised message from the person's general practice endorsing the kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care, comprising at-home testing with a faecal immunochemical test (FIT) through the NBCSP. The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12 months from randomisation, which was estimated using generalised linear model regression.

RESULTS: In total, 39.2% (1143/2914) of people in 11 intervention practices and 23.0% (583/2537) of people in 10 control practices had a FIT result in their electronic health records - a difference of 16.5% (95% confidence interval = 2.02 to 30.9).

CONCLUSION: The SMS intervention increased NBCSP kit return in 50-60-year-old patients in general practice. This finding informed a larger trial - SMARTERscreen - to test this intervention in a broader Australian population.

Discipline Area Score
Nurse 6 / 7
Physician 6 / 7
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Comments from MORE raters

Nurse rater

The effectiveness of this approach is well known. Many services (dental appointments, banking services and others...) now use it to prevent no-shows and improve compliance.

Nurse rater

This is very useful information. I am working with a community project on delivering FIT kits and this evidence speaks to what is needed in addition to giving the FIT kits. This information is certainly beneficial to disseminate, especially to primary care providers as well as community outreach.

Physician rater

A very useful experience to share with colleagues regarding potential IT intervention that will enable primary care teams to improve participation in screening programmes.
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