采用简化补充信息传单降低 NHS 肠癌筛查计划的社会经济梯度参与率：一项聚类随机试验。
Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial.
机构信息
Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LB, UK.
Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK.
出版信息
BMC Cancer. 2017 Aug 14;17(1):543. doi: 10.1186/s12885-017-3512-1.
BACKGROUND
Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the 'gist' of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP.
METHODS
The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59-74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet ('SI'). The intervention group received the SI booklet and the Gist leaflet ('SI + Gist') which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.
RESULTS
In November 2012, 163,525 individuals were allocated to either the 'SI' intervention (n = 79,104) or the 'SI + Gist' group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92-1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.
CONCLUSIONS
Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.
TRIAL REGISTRATION
ISRCTN74121020 , registered: 17/20/2012.
背景
在英国国民保健制度（NHS）大肠癌筛查计划（BCSP）中，结直肠癌筛查的参与率很低。参与筛查与社会经济地位密切相关。本研究旨在确定提供基于愈创木脂的粪便潜血试验（gFOBt）筛查结直肠癌的“要点”补充单页是否可以减少英国 NHS BCSP 中筛查的社会经济地位（SES）梯度。
方法
该试验于 2012 年 11 月纳入常规 BCSP 运营。采用整群随机对照设计，所有年龄在 59-74 岁之间的成年人，按邀请日期随机分配进行常规 gFOBt 检查。使用多因素剥夺指数（Index of Multiple Deprivation）创建 SES 五分位数。对照组接受标准信息手册（“SI”）。干预组接受 SI 手册和要点传单（“SI+Gist”），旨在帮助文化程度较低的人参与邀请。集线器无法实现盲法，受邀对象也不知道有对照条件。主要结局是 IMD 五分位数的参与梯度。
结果
2012 年 11 月，共有 163525 人被分配至“SI”干预组（n=79104）或“SI+Gist”组（n=84421）。干预组和对照组的总体参与率相似（SI：57.3%，SI+Gist：57.6%；OR=1.02，95%CI：0.92-1.13，p=0.77）。在最贫困五分位数组中，参与率为 42.0%（SI）与 43.0%（SI+Gist），在最富裕五分位数组中，参与率为 65.6%与 65.8%（交互作用 p=0.48）。在年龄、性别、集线器和筛查轮次亚组中，两组之间的参与 SES 梯度相似。
结论
除标准信息手册外，提供补充简化信息并不能降低 NHS BCSP 中的 SES 参与梯度。在未来的研究中，应探索要点传单单独使用的有效性。
试验注册
ISRCTN74121020，注册日期：2012 年 10 月 17 日。
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