Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Lancet. 2023 Nov;402 Suppl 1:S82. doi: 10.1016/S0140-6736(23)02153-0.
Lung cancer is the most common cause of cancer death in the UK, and incidence is strongly associated with increasing age. Screening can improve survival by detecting cancer earlier. Targeted Lung Health Check (TLHC) programme is a lung cancer screening pilot offered to smokers or ex-smokers aged 55-74 years in certain areas of England. However, uptake remains as low as 20% in London. We did a service evaluation to assess the effect of adding messaging informed by behaviour science to invitation letters on TLHC uptake.
The intervention involved adding to the standard invitation letter a box with a two-sentence behavioural message targeted at mitigating fatalistic beliefs and low risk perception, as well as promoting clinician endorsement and the value of early detection. Allocation to receive either standard or intervention letters was done at West London GP practice level, with approximate pairing between practices. From Sept 22, 2022, to Nov 28, 2022, 9464 invitations were sent to eligible individuals (4842 standard and 4622 intervention) covering 20 GP practices. The primary outcome (uptake) was a booked appointment date within 4 months of the invitation letter being sent. TIDieR checklist was used for methodology and reporting guidelines. We used χ analysis to test for significant differences in uptake, and mixed-effects logistic regression to control for demographic covariates.
Demographic characteristics were similar in the control and intervention groups, with mean ages of 63·3 and 63·0 years, average index of multiple deprivation (IMD) deciles of 6·33 and 5·53, and percentage of female participants 42·1% (n=2038) and 43·7% (n=2022), respectively. Uptake of TLHC was significantly higher in the intervention group (25·8%, n=1192) than in the control group (20·4%, n=987; χ(1)=38·762, p<0·0001). A logistic regression model estimated likelihood of uptake was 37·5% (95% CI 12·1-63·2) higher in the intervention group (p=0·004). Patients aged 60-64, 65-69 and 70-75 years were 23·5% (10·7-36·3, p=0·0003), 28·3% (14·5-42·0, p<0·0001), and 32·6% (18·3-47·0, p<0·0001) more likely to attend than those aged 55-59 years. The likelihood of attendance decreased on the basis of deprivation (IMD decile; b=0·060, 95% CI 0·035-0·087, p<0·0001), female gender (b=0·156, 0·057-0·254, p=0·002), and for ex-smokers compared with smokers (b=0·580, 0·467-0·693, p<0·0001).
This simple, no-cost addition of behavioural messaging to invitation letters can significantly improve screening uptake and is recommended for wider rollout. These findings are consistent with other studies. However, a limitation is that the allocation to study arm was at GP practice level and the study was not randomised.
RM Partners, the West London Cancer Alliance.
肺癌是英国最常见的癌症死因，其发病率与年龄增长密切相关。筛查可以通过更早地发现癌症来提高生存率。靶向性肺癌健康检查（TLHC）计划是一项在英格兰某些地区提供给 55-74 岁吸烟者或前吸烟者的肺癌筛查试点项目。然而，伦敦的参与率仍然低至 20%。我们进行了一项服务评估，以评估在邀请信中添加基于行为科学的信息对 TLHC 参与率的影响。
干预措施包括在标准邀请信中添加一个带有两句话的行为信息框，旨在减轻宿命论信念和低风险感知，并促进临床医生的认可和早期检测的价值。所有邀请信都按照西伦敦全科医生实践水平进行了分配，实践之间进行了大致配对。从 2022 年 9 月 22 日至 2022 年 11 月 28 日，向 9464 名符合条件的个人（4842 名标准和 4622 名干预）发送了邀请信，涵盖了 20 家全科医生实践。主要结果（参与率）是在邀请信发出后 4 个月内预约的日期。TIDieR 清单用于方法学和报告指南。我们使用 χ2 分析检验参与率的显著差异，并使用混合效应逻辑回归控制人口统计学协变量。
对照组和干预组的人口统计学特征相似，平均年龄分别为 63.3 岁和 63.0 岁，平均综合多因素剥夺指数（IMD）十分位数分别为 6.33 和 5.53，女性参与者的比例分别为 42.1%（n=2038）和 43.7%（n=2022）。干预组 TLHC 的参与率明显高于对照组（25.8%，n=1192）（20.4%，n=987；χ2（1）=38.762，p<0.0001）。回归模型估计干预组的参与可能性高出 37.5%（95%CI 12.1-63.2）（p=0.004）。60-64 岁、65-69 岁和 70-75 岁的患者分别有 23.5%（10.7-36.3，p=0.0003）、28.3%（14.5-42.0，p<0.0001）和 32.6%（18.3-47.0，p<0.0001）更有可能就诊。根据贫困程度（IMD 十分位数；b=0.060，95%CI 0.035-0.087，p<0.0001）、性别（b=0.156，0.057-0.254，p=0.002）和与吸烟者相比的前吸烟者（b=0.580，0.467-0.693，p<0.0001），就诊的可能性会降低。
这种简单的、无需成本的在邀请信中添加行为信息的方法可以显著提高筛查参与率，建议广泛推广。这些发现与其他研究一致。然而，一个限制是，研究臂的分配是在全科医生实践层面进行的，研究不是随机的。
RM Partners，西伦敦癌症联盟。
