Denis B, Broc G, Sauleau E A, Gendre I, Gana K, Perrin P
Association for colorectal cancer screening in Alsace, 68024 Colmar, France.
Psychology Laboratory EA 4139, Bordeaux Segalen University, 33076 Bordeaux, France.
Rev Epidemiol Sante Publique. 2017 Feb;65(1):17-28. doi: 10.1016/j.respe.2016.06.336. Epub 2017 Jan 11.
Despite the involvement of general practitioners, the mailing of several recall letters and of the faecal occult blood test (FOBT) kit, the uptake remains insufficient in the French colorectal cancer-screening programme. Some studies have demonstrated a greater efficacy of tailored telephone counselling over usual care, untailored invitation mailing and FOBT kit mailing. We evaluated the feasibility and the effectiveness of telephone counselling on participation in the population-based FOBT colorectal cancer-screening programme implemented in Alsace (France).
Underusers were randomized into a control group with untailored invitation and FOBT kit mailing (n=19,756) and two intervention groups for either a computer-assisted telephone interview (n=9367), system for tailored promotion of colorectal cancer screening, or a telephone-based motivational interview (n=9374).
Only 5691 (19.9%) people were actually counseled, so that there was no difference in participation between the intervention groups taken together (13.9%, 95% confidence interval [CI] [13.5-14.4]) and the control group (13.9%, 95% CI [13.4-14.4]) (P=1.0) in intent-to-treat analysis. However, in per-protocol analysis, participation was significantly higher in the two intervention groups than in the control group (12.9%, 95% CI [12.6-13.2]) (P<0.01), with no difference between computer-assisted telephone interview (24.6%, 95% CI [22.7-26.4]) and motivational interview (23.6%, 95% CI [21.8-25.4]) (P=0.44).
There was no difference of effectiveness between tailored telephone counselling and untailored invitation and FOBT kit mailing on participation of underusers in an organized population-based colorectal cancer screening programme. A greater efficacy of telephone counselling, around twice that of invitation and FOBT kit mailing, was observed only in people who could actually be counseled, without difference between computer-assisted telephone interview and motivational interview. However, technical failures hampered telephone counselling, so that there was no difference in intent-to-treat analysis. The rate of technical success of telephone interviews should be evaluated, and enhanced if insufficient, before implementation of telephone counselling in population-based cancer screening programmes.
尽管有全科医生参与，多次邮寄召回信和粪便潜血试验（FOBT）试剂盒，但在法国的结直肠癌筛查项目中，参与率仍然不足。一些研究表明，针对性的电话咨询比常规护理、非针对性的邀请邮件和FOBT试剂盒邮件更有效。我们评估了电话咨询对参与法国阿尔萨斯地区实施的基于人群的FOBT结直肠癌筛查项目的可行性和有效性。
未充分利用筛查服务者被随机分为对照组（接受非针对性的邀请和FOBT试剂盒邮件，n = 19756）和两个干预组，一组接受计算机辅助电话访谈（n = 9367，一种针对性促进结直肠癌筛查的系统），另一组接受基于电话的动机访谈（n = 9374）。
实际接受咨询的只有5691人（19.9%），因此在意向性分析中，两个干预组合并后的参与率（13.9%，95%置信区间[CI][13.5 - 14.4]）与对照组（13.9%，95% CI[13.4 - 14.4]）之间没有差异（P = 1.0）。然而，在符合方案分析中，两个干预组的参与率显著高于对照组（12.9%，95% CI[12.6 - 13.2]）（P < 0.01），计算机辅助电话访谈组（24.6%，95% CI[22.7 - 26.4]）和动机访谈组（23.6%，95% CI[21.8 - 25.4]）之间没有差异（P = 0.44）。
在基于人群的有组织的结直肠癌筛查项目中，针对性的电话咨询与非针对性的邀请和FOBT试剂盒邮件在未充分利用筛查服务者的参与率方面没有效果差异。仅在实际能够接受咨询的人群中观察到电话咨询的效果约为邀请和FOBT试剂盒邮件的两倍，计算机辅助电话访谈和动机访谈之间没有差异。然而，技术故障阻碍了电话咨询，因此在意向性分析中没有差异。在基于人群的癌症筛查项目中实施电话咨询之前，应评估电话访谈的技术成功率，若不足则加以提高。
