Dr Robert Kerrison


Lecturer in Cancer Care
BSc, MSc, PhD

Academic and research departments

Cancer research cluster, School of Health Sciences.

My publications

Publications

Sandro Stoffel, ROBERT STEPHEN KERRISON, Ivo Vlaev, C von Wagner (2020)Offering male endoscopists as decoy option to nudge disinclined women to have colorectal cancer screening, In: Journal of behavioral medicine43(3)pp. 511-518 Springer

Previous studies have shown that a large proportion of women invited for bowel cancer screening prefer endoscopists of the same gender. We tested whether women who are initially disinclined to undergo flexible sigmoidoscopy screening would be more willing to have the test with a female practitioner if they were also offered a decoy appointment with a male practitioner. We conducted two online experiments with women aged 35-54, living in England, who did not intend to undergo flexible sigmoidoscopy screening. In both experiments, women were randomised to two conditions: (1) control (appointment with a female endoscopist) and (2) decoy (two appointments to choose from, one with a male endoscopist and one with a female endoscopist). Experiment 1 (N = 302) verified the conditions for the decoy using a conventional intention scale, while experiment 2 (N = 300) tested how the presence of the decoy influences the likelihood of women choosing the appointment with the female practitioner in a discrete choice task. While experiment 1 showed that the presence of the decoy increased intentions to attend the appointment with the female practitioner (p = 0.02), experiment 2 confirmed that women were more likely to choose the appointment with the female endoscopist if they were also offered the decoy (p 

Sandro Stoffel, Y Hirst, A Ghanouni, L McGregor, ROBERT STEPHEN KERRISON, Wouter Verstraete, A Gallagher, Jo Waller, Christian von Wagner (2019)Testing active choice for screening practitioner's gender in endoscopy among disinclined women: An online experiment, In: Journal of medical screening26(2)pp. 98-103

A large proportion of women have a preference for a same-gender endoscopy practitioner. We tested how information about practitioner gender affected intention to have bowel scope screening in a sample of women disinclined to have the test. In an online experimental survey, women aged 35-54 living in England who did not intend to participate in bowel scope screening (N = 1060) were randomised to one of four experimental conditions: (1) control (practitioner's gender is unknown), (2) opposite-gender (male practitioner by default), (3) same gender (female practitioner by default), and (4) active choice (the patient could choose the gender of the practitioner). Intention was measured following the interventions. Of 1010 (95.3%) women who completed the survey, most were White-British (83.6%), and working (63.3%). Compared with control, both active choice and same-gender conditions increased intention among disinclined women (9.3% vs. 16.0% and 17.9%; OR: 1.85; 95% CI: 1.07-3.20 and OR: 2.07; 95% CI: 1.23-3.50). There were no differences in intention between the opposite-gender and control conditions (9.8% vs. 9.3%; OR: 1.06; 95% CI: 0.60-1.90) or the active choice and same-gender conditions (16.0% vs. 17.9%: OR: 0.89; 95% CI: 0.55-1.46, using same gender as baseline). Offering disinclined women a same-gender practitioner, either by choice or default, increased subsequent intention, while an opposite gender default did not negatively affect intention. Reducing uncertainty about gender of practitioner could positively affect uptake in women, and should be tested in a randomised controlled trial.

Sarah Huf, Robert S. Kerrison, Dominic King, Tim Chadborn, Adele Richmond, DA Cunningham, E Friedman, H Shukla, Fu-Min Tseng, Gaby Judah, A Darzi, Ivo Vlaev (2020)Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials, In: Preventive Medicine139106170 Elsevier

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February–October 2015 were eligible. 3133 women aged 24–29 (Study 1) were randomized (1, 1) to ‘no SMS’ (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30–64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09–1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03–1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02–1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.

Robert S. Kerrison, Christian von Wagner , TJ Green, Monica Gibbins, U Macleod, Mark Hughes, Colin Rees, Stephen Duffy , L McGregor (2019)Rapid review of factors associated with flexible sigmoidoscopy screening use, In: Preventive medicine120pp. 8-18 Elsevier

Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding ‘OR’ terms) until the number of new publications eligible after abstract review was

Y Hirst, Robert Kerrison, Lindsay C. Kobayashi, N Counsell, Natasha Djedovic, Josephine Ruwende, M Stewart, Christian von Wagner (2016)Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial, In: BMC Public Health1674 BMC

Screening with the guaiac faecal occult blood test (gFOBt) is associated with improved colorectal cancer (CRC) survival, and is offered biennially to men and women aged 60-74 years in England's national Bowel Cancer Screening Programme (BCSP). Uptake of the gFOBt is low, with only 54 % of the eligible population completing the test. Text-message reminders could improve uptake of gFOBt. This paper describes the protocol for a randomised controlled trial, which will examine the effectiveness of a text-message reminder to promote uptake of gFOBt screening in the BCSP. Individual mobile telephone data from 180 general practices in London with existing mobile-health services will be linked to the national BCSP information system via a secure on-line network. All screening-eligible adults registered with a participating practice will be randomised, to receive either usual care (N = 1600) or usual care plus a text-message reminder to self-complete and return their kit eight weeks after their initial invitation (N = 1600). The primary outcome will be the proportion of individuals who return an adequately completed gFOBt kit within 18 weeks of the initial invitation. Differences in uptake between groups will be evaluated using a logistic regression analysis, adjusting for individual-level and area-level socio-demographic variables. This will be the first large-scale randomised trial of a text-message reminder in a national screening programme for CRC. If effective, this study provides a cost-effective means to promote uptake of CRC screening in an organised programme. Current Controlled Trials ISRCTN70904476 (18/09/2015).

Christian von Wagner , B Bonello, Sandro Stoffel, H. Skrobanski, R. Kerrison, L McGregor (2019)Predictors of intention translation in flexible sigmoidoscopy screening for colorectal cancer, In: Health Psychology38(12)pp. 1083-1095 American Psychological Association

Objective: This prospective study aimed to identify predictors of intention and subsequent attendance of flexible sigmoidoscopy screening using constructs derived from the Health Belief Model (HBM). Method: A total of 4,330 people aged 54 years and registered at 1 of 83 participating English general practices were sent a preinvitation questionnaire to assess sociodemographics, HBM variables including perceived benefits, barriers, seriousness, health motivation, and external cues to action as well a range of other constructs and personal characteristics known to relate to cancer screening. Results: Of the 1,578 respondents (36.4%), 1,555 (98.5%) answered the intention question: 52.9% stated definitely yes, 38.1% probably yes, 6.8% probably not, and 2.2% definitely not. Intentions were positively associated with a higher score on a scale of benefits (odds ratio [OR] = 4.62; 95% confidence intervals [CI; 3.24, 6.59]) and health motivation, that is, interest in other ways of preventing colorectal cancer (OR = 2.61; 95% CI [1.62, 4.22]), while a higher score on perceived barriers (OR = 0.19; 95% CI [0.12, 0.31]) and currently following recommended healthy lifestyle behaviors (OR = 0.31; 95% CI [0.16, 0.59]) were negatively associated. Attendance was verified for 922 intenders (65.2%) of whom 737 (79.9%) attended. Attendance was predicted by health motivation (OR = 1.75; 95% CI [1.07, 2.86]), perceived benefits (OR = 1.82; 95% CI [1.37, 2.43]), perceived barriers (OR = 0.47; 95% CI [0.32, 0.69]), individual-level deprivation (OR = 0.26; 95% CI [0.14, 0.50]), and having diabetes (OR = 0.48; 95% CI [0.25, 0.94]). Conclusion: This study supported the usefulness of the HBM in predicting cancer screening and was further enhanced by adding non-HBM variables such as individual socioeconomic deprivation and comorbidities.

L McGregor, Robert S. Kerrison, TJ Green, U Macleod, Mark Hughes, Monica Gibbins, Stephen Morris, Colin Rees, Christian von Wagner (2018)Using primary care-based paper and telephone interventions to increase uptake of bowel scope screening in Yorkshire: a protocol of a randomised controlled trial, In: BMJ open8(7)e024616 BMJ Publishing Group

Introduction: Evidence suggests bowel scope screening (BSS) can significantly reduce an individual’s risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance. Methods and analysis: A three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual’s GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual’s GP practice and a patient navigation call made on behalf of an individual’s GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation. Ethics and dissemination: NHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Sandro Stoffel, Stala Kioupi, Despina Ioannou, Robert S. Kerrison, Christian von Wagner , Benedikt Herrmann (2021)Testing messages from behavioral economics to improve participation in a population-based colorectal cancer screening program in Cyprus: Results from two randomized controlled trials, In: Preventive Medicine Reports24101499 Elsevier

Despite the benefits of colorectal cancer (CRC) screening, participation compares poorly to other screening programs. This study assessed the effectiveness of adding different behavioral economic-based messages, to the invitation letter, to increase uptake in the Cypriot CRC screening program. We performed two randomized controlled trials. In the first trial (‘Trial 1’), 3212 individuals, aged 50 to 69 years, were randomly allocated (1:1:1:1:1:1:1) to one of six intervention groups, or the control. The intervention groups received the standard invitation letter received by the control, with the addition of one of six messages based on the following behavioral economics principles: (1) social responsibility, (2) anticipated regret, (3) financial opportunity costs (of non-attendance), (4) benefit (of early detection), (5) scarcity effect (limited duration of the offer) and (6) social norms. The second trial (‘Trial 2’) tested the most efficacious message (social responsibility) against the control in a larger sample (N = 3074). In both trials, the primary outcome was uptake eight weeks after the screening invitation. In trial 1, overall uptake was 20.6%. There were no significant differences between the control and the intervention conditions for the overall sample or men (all p’s > 0.05). Highlighting the social consequences of cancer did, however, increase uptake rates among women (25.6% vs. 17.1%, aOR 1.67; 95% CI 1.05–2.66, p = 0.031). We, therefore, tested this message in Trial 2. Uptake was similar to trial 1 with 20.7% (intervention: 20.8% vs control: 20.6%) and there was no impact on overall or uptake of men and women separately (all p’s > 0.05).

Sandro Stoffel, Mariella Bombagi, Robert S. Kerrison, Christian von Wagner , Benedikt Herrmann (2021)Testing Enhanced Active Choice to Optimize Acceptance and Participation in a Population-Based Colorectal Cancer Screening Program in Malta, In: Behavioral Medicine Taylor & Francis

Opt-out strategies have been shown to improve participation in cancer screening; however, there are ethical concerns regarding the presumed consent. In this study, we tested an alternative opt-in strategy, called: "enhanced active choice," in which the response options summarize the consequences of the decision. The study was conducted as part of the Maltese colorectal cancer screening program, which offers men and women, aged 60-64, a "one-off" fecal immunochemical test (FIT). A total of 8349 individuals were randomly assigned to receive either an invitation letter that featured a standard opt-in strategy (control condition), or an alternative letter with a modified opt-in strategy (enhanced active choice condition). Our primary outcome was participation three months after the invitation was delivered. Additionally, we also compared the proportion who said they wanted to take part in screening. We used multivariable logistic regression for the analysis. Overall, 48.4% (N = 4042) accepted the invitation and 42.4% (N = 3542) did the screening test. While there were no statistically significant differences between the two conditions in terms of acceptance and participation, enhanced active choice did increase acceptance among men by 4.6 percentage points, which translated to a significant increase in participation of 3.4 percentage points. We conclude that enhanced active choice can improve male screening participation. Given the higher risk of CRC in men, as well as their lower participation screening, we believe this to be an important finding.

Christian von Wagner , Y Hirst, Sara Tookey, Robert S. Kerrison, S Marshall, A Prentice, Daniel Vulkan, U Macleod, Stephen Duffy (2018)Use of a GP-endorsed 12 months’ reminder letter to promote uptake of bowel scope screening: protocol for a randomised controlled trial in a hard-to-reach population, In: BMJ Open8(5)e022263

Introduction Flexible sigmoidoscopy (FS) screening is associated with reduced colorectal cancer incidence and mortality when offered as a one-off test to men and women aged 55–64. The test, also referred to as the ‘bowel scope screening’ (BSS) test, was added to England’s national Bowel Cancer Screening Programme in March 2013, where it is offered to men and women aged 55. Since its implementation, uptake of the BSS test has been low, with only 43% of the eligible population attending an appointment. Sending non-participants a reminder at age 56 has been shown to improve uptake by up to nine percentage points at a single centre in London; we hypothesise that adding a general practitioners (GPs) endorsement to the reminder could improve uptake even further. Methods and analysis This paper describes the protocol for a randomised controlled trial which will examine the effectiveness of adding a GPs endorsement to a reminder for BSS non-participants aged 56. All screening-eligible adults who have not responded to a BSS appointment at London North West Healthcare NHS Trust within 12 months of their initial invitation will be randomised to receive either a GP-endorsed reminder letter or reminder letter without GP endorsement. The primary outcome will be the proportion of individuals screened within each group 8 weeks after the reminder. Statistical comparisons will be made using univariate and multivariate logistic regression, with ‘uptake’ as the outcome variable, GP reminder group as the exposure and sociodemographic variables as covariates. Ethics and dissemination The study was approved by the Yorkshire & Humber—Bradford Leeds Research Ethics Committee (16/YH/0298) and the Confidentiality Advisory Group (17/CAG/0162). The results will be disseminated in a peer-reviewed journal in accordance with the Consort statement and will be made available to the public.

R. S. Kerrison, A Prentice, S Marshall, S Choglay, Sandro Stoffel, Colin Rees, C von Wagner (2021)Implementation of long-term non-participant reminders for flexible sigmoidoscopy screening, In: Preventive Medicine Reports21101308 Elsevier

The clinical effectiveness of screening is highly dependent on uptake. Previous randomised controlled trials suggest that non-participant reminders, which highlight the opportunity to re-book an appointment, can improve participation. The present analysis examines the impact of implementing these reminders within the English Flexible Sigmoidoscopy (FS) Screening Programme, which offers once-only FS screening to adults aged 55–59 years. We assessed the screening status of 26,339 individuals invited for once-only FS screening in England. A total of 10,952 (41.6%) had attended screening, and were subsequently ineligible. The remaining 15,387 had not attended screening, and were selected to receive a reminder, 1–2 years after their invitation. Descriptive statistics were used to assess the increase in uptake and the adenoma detection rate (ADR) of those who self-referred, six months after the delivery of the final reminder. Pearson’s Chi-Square was used to compare the ADR between those who attended when invited and those who self-referred. Of the 15,387 adults eligible to receive a reminder, 13,626 (88.6%) were sent a reminder as intended (1,761 were not sent a reminder, due to endoscopy capacity). Of these, 8.0% (n = 1,086) booked and attended an appointment, which equated to a 4.1% increase in uptake from 41.6% at baseline, to 45.7% at follow-up. The ADR was significantly higher for those who self-referred, compared with those who attended when invited (13.3% and 9.5%, respectively; X2 = 16.138, p = 0.000059). The implementation of non-participant reminders led to a moderate increase in uptake. Implementing non-participant reminders could help mitigate the negative effects of COVID-19 on uptake.

Christian von Wagner , Y Hirst, Jo Waller, A Ghanouni, L McGregor, ROBERT STEPHEN KERRISON, Wouter Verstraete, Ivo Vlaev, Monika Sieverding, Sandro Stoffel (2019)The impact of descriptive norms on motivation to participate in cancer screening – Evidence from online experiments, In: Patient education and counseling102(9)pp. 1621-1628 Elsevier B.V

•Two online experiments testing descriptive social norms in cancer screening.•Increasing perceived uptake is positively associated with screening intention.•Providing feedback about normative beliefs does not affect perceived credibility of the uptake message.•The least credible messages stating highest uptake had largest effect on intentions. The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals. 2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant’s estimate, as well as the stated proportion of men and women doing the screening test. Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit. Screening intention can be effectively manipulated through a high uptake message. Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.

ROBERT STEPHEN KERRISON, L McGregor, N Counsell, S Marshall, A Prentice, John Isitt, Colin Rees, Christian von Wagner (2018)Use of Two Self-referral Reminders and a Theory-Based Leaflet to Increase the Uptake of Flexible Sigmoidoscopy in the English Bowel Scope Screening Program: Results From a Randomized Controlled Trial in London, In: Annals of behavioral medicine52(11)pp. 941-951 Oxford University Press

Reminder letters, which prompt ‘no-shows’ to self-refer for bowel cancer screening, increase uptake and thereby the total number of pre-cancerous lesions detected.

ROBERT STEPHEN KERRISON, L McGregor, S Marshall, John Isitt, N Counsell, J Wardle, Christian von Wagner (2016)Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study, In: British journal of cancer114(7)pp. 751-758 British Journal of Cancer

In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include 'one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake. This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final. Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02-7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90%) indicated a preference for a same-sex practitioner, whereas three (10%) gave no preference. Preference for a same-sex practitioner was higher among women than men (χ(2)=7.78, P

ROBERT STEPHEN KERRISON, L McGregor, S Marshall, John Isitt, N Counsell, Colin Rees, Christian von Wagner (2017)Improving uptake of flexible sigmoidoscopy screening: a randomized trial of nonparticipant reminders in the English Screening Programme, In: Endoscopy49(1)pp. 35-43 Georg Thieme Verlag KG

Abstract Background and study aims  Uptake of flexible sigmoidoscopy screening in the English Bowel Scope Screening (BSS) Programme is low. The aim of this study was to test the impact of a nonparticipant reminder and theory-based leaflet to promote uptake among former nonresponders (previously did not confirm their appointment) and nonattenders (previously confirmed their appointment but did not attend). Patients and methods  Eligible adults were men and women in London who had not attended a BSS appointment within 12 months of their invitation. Individuals were randomized (1:1:1) to receive no reminder (control), a 12-month reminder plus standard information booklet (TMR-SIB), or a 12-month reminder plus bespoke theory-based leaflet (TMR-TBL) designed to address barriers to screening. The primary outcome of the study was the proportion of individuals screened within each group 12 weeks after the delivery of the reminder. Results  A total of 1383 men and women were randomized and analyzed as allocated (n = 461 per trial arm). Uptake was 0.2 % (n = 1), 10.4 % (n = 48), and 15.2 % (n = 70) in the control, TMR-SIB, and TMR-TBL groups, respectively. Individuals in the TMR-SIB and TMR-TBL groups were significantly more likely to attend screening than individuals in the control group (adjusted odds ratio [OR] 53.7, 95 % confidence interval [CI] 7.4 – 391.4, P  

ROBERT STEPHEN KERRISON, S Moss, C Mathews, T Day, Steve Smith, HE Seaman, J Snowball, Stephen P Halloran (2017)Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England, In: Gut66(9)pp. 1631-1644 BMJ

BackgroundThe National Health Service Bowel Cancer Screening Programme (BCSP) in England uses a guaiac-based faecal occult blood test (gFOBt). A quantitative faecal immunochemical test (FIT) for haemoglobin (Hb) has many advantages, including being specific for human blood, detecting Hb at a much lower concentration with a single faecal sample and improved uptake.MethodsIn 2014, a large comparative pilot study was performed within BCSP to establish the acceptability and diagnostic performance of FIT. Over a 6-month period, 40 930 (1 in 28) subjects were sent a FIT (OC-SENSOR) instead of a gFOBt. A bespoke FIT package was used to mail FIT sampling devices to and from FIT subjects. All participants positive with either gFOBt or FIT (cut-off 20 µg Hb/g faeces) were referred for follow-up. Subgroup analysis included cut-off concentrations, age, sex, screening history and deprivation quintile.ResultsWhile overall uptake increased by over 7 percentage points with FIT (66.4% vs 59.3%, OR 1.35, 95% CI 1.33 to 1.38), uptake by previous non-responders almost doubled (FIT 23.9% vs gFOBt 12.5%, OR 2.20, 95% CI 2.10 to 2.29). The increase in overall uptake was significantly higher in men than women and was observed across all deprivation quintiles. With the conventional 20 µg/g cut-off, FIT positivity was 7.8% and ranged from 5.7% in 59–64-year-old women to 11.1% in 70–75-year-old men. Cancer detection increased twofold and that for advanced adenomas nearly fivefold. Detection rates remained higher with FIT for advanced adenomas, even at 180 µg Hb/g.ConclusionsMarkedly improved participation rates were achieved in a mature gFOBt-based national screening programme and disparities between men and women were reduced. High positivity rates, particularly in men and previous non-respondents, challenge the available colonoscopy resource, but improvements in neoplasia detection are still achievable within this limited resource.

L McGregor, B Bonello, ROBERT STEPHEN KERRISON, C Nickerson, G Baio, Lindy Berkman, Colin Rees, WS Atkin, J Wardle, Christian von Wagner (2016)Uptake of Bowel Scope (Flexible Sigmoidoscopy) Screening in the English National Programme: the first 14 months, In: Journal of medical screening23(2)pp. 77-82 Sage

To examine uptake in the first six pilot centres of the English Bowel Scope Screening (BSS) programme, which began in early 2013 and invites adults aged 55 for a one off Flexible Sigmoidoscopy. Between March 2013 and May 2014 the six pilot centres sent 21,187 invitations. Using multivariate logistic regression analysis, we examined variation in uptake by gender, socioeconomic deprivation (using the Index of Multiple Deprivation), area-based ethnic diversity (proportion of non-white residents), screening centre, and appointment time (routine: daytime vs out-of-hours: evening/weekend). Uptake was 43.1%. Men were more likely to attend than women (45% vs 42%; OR 1.136, 95% CI 1.076, 1.199, p 

ROBERT STEPHEN KERRISON, H Shukla, DA Cunningham, O Oyebode, E Friedman (2015)Text-message reminders increase uptake of routine breast screening appointments: a randomised controlled trial in a hard-to-reach population, In: British journal of cancer112(6)pp. 1005-1010 Springer Nature

There is a need for interventions to promote uptake of breast screening throughout Europe. We performed a single-blind randomised controlled trial to test whether text-message reminders were effective. Two thousand two hundred and forty women receiving their first breast screening invitation were included in the study and randomly assigned in a 1 : 1 ratio to receive either a normal invitation only (n=1118) or a normal invitation plus a text-message reminder 48 h before their appointment (n=1122). In the intention-to-treat analysis, uptake of breast screening was 59.1% among women in the normal invitation group and 64.4% in the text-message reminder group (χ(2)=6.47, odds ratio (OR): 1.26, 95% confidence intervals (CI): 1.05-1.48, P=0.01). Of the 1122 women assigned to the text-message reminder group, only 456 (41%) had a mobile number recorded by their GP and were thereby sent a text. In the per-protocol analysis, uptake by those in the control group who had a mobile number recorded on the GP system was 59.77% and by those in the intervention group who were sent a reminder 71.7% (χ(2)=14.12, OR=1.71, 95% CI=1.29-2.26, P

Objectives: In England, a significant proportion of people who take part in the national bowel cancer screening programme (BCSP) and have a positive faecal occult blood test (FOBt) result, do not attend follow-up colonoscopy (CC). The aim of this study was to investigate differences in intended participation in a follow-up investigation by diagnostic modality offered including CC, CT colonography (CTC) or capsule endoscopy (CE). Setting: We performed a randomised online experiment with individuals who had previously completed an FOBt as part of the English BCSP. Methods: Participants (n=953) were randomly allocated to receive one of three online vignettes asking participants to imagine they had received an abnormal FOBt result, and that they had been invited for a follow-up test. The follow-up test offered was either: CC (n=346), CTC (n=302) or CE (n=305). Participants were then asked how likely they were to have their allocated test or if they refused, either of the other tests. Respondents were also asked to cite possible emotional and practical barriers to follow up testing. Multivariable logistic regression models were used to investigate intentions. Results: Intention to have the test was higher in the CTC group (96.7%) compared with the CC group (91.8%; OR 2.64; 95% CI 1.22 to 5.73). CTC was considered less ‘off-putting’ (OR 0.66, 95% CI 0.47 to 0.94) and less uncomfortable compared with CC (OR 0.51, 95% CI 0.34 to 0.77). For those who did not intend to have the test they were offered, CE (39.7%) or no investigation (34.5%) was preferable to CC (8.6%) or CTC (17.2%). Conclusions: Alternative tests have the potential to increase attendance at diagnostic follow-up appointments.

Robert S. Kerrison, A Prentice, S Marshall, S Choglay, Michael Levitan, Marsha Alter, A Ghanouni, L McGregor, Daniel Vulkan (2021)Ethnic inequalities in older adults bowel cancer awareness: findings from a community survey conducted in an ethnically diverse region in England, In: BMC Public Health21513 BMC

To date, research exploring the public's awareness of bowel cancer has taken place with predominantly white populations. To enhance our understanding of how bowel cancer awareness varies between ethnic groups, and inform the development of targeted interventions, we conducted a questionnaire study across three ethnically diverse regions in Greater London, England. Data were collected using an adapted version of the bowel cancer awareness measure. Eligible adults were individuals, aged 60+ years, who were eligible for screening. Participants were recruited and surveyed, verbally, by staff working at 40 community pharmacies in Northwest London, the Harrow Somali association, and St. Mark's Bowel Cancer Screening Centre. Associations between risk factor, symptom and screening awareness scores and ethnicity were assessed using multivariate regression. 1013 adults, aged 60+ years, completed the questionnaire; half were of a Black, Asian or Minority ethnic group background (n = 507; 50.0%). Participants recognised a mean average of 4.27 of 9 symptoms and 3.99 of 10 risk factors. Symptom awareness was significantly lower among all ethnic minority groups (all p's 

Robert S. Kerrison, Elizabeth Travis, Christina Dobson, Katriina L. Whitaker, Colin Rees, Stephen Duffy , Christian von Wagner (2021)Barriers and facilitators to colonoscopy following fecal immunochemical test screening for colorectal cancer: A key informant interview study, In: Patient Education and Counseling Elsevier

Objectives People who are referred for colonoscopy, following an abnormal colorectal cancer (CRC) screening result, are at increased risk of CRC. Despite this, many individuals decline the procedure. The aim of this study was to investigate why. Methods As little is currently known about non-attendance at follow-up colonoscopy, and follow-up of abnormal screening results is a nurse-led process, we decided to conduct key informant interviews with Specialist Screening Practitioners ([SSPs] nurses working in the English Bowel Cancer Screening Program). Interviews were conducted online. Transcripts were assessed using inductive and deductive coding techniques. Results 21 SSPs participated in an interview. Five main types of barriers and facilitators to colonoscopy were described, namely: Sociocultural, Practical, Psychological, Health-related and COVID-related. Key psychological and sociocultural factors included: ‘Fear of pain and discomfort associated with the procedure’ and ‘Lack of support from family and friends’. Key practical, health-related and COVID-related factors included: ‘Family and work commitments’, ‘Existing health conditions as competing priorities’ and ‘Fear of getting COVID-19 at the hospital'. Conclusions A range of barriers and facilitators to follow-up colonoscopy exist. Future studies conducted with patients are needed to further explore barriers to colonoscopy. Practice implications Strategies to reduce non-attendance should adopt a multifaceted approach.

Aradhna Kaushal, Y Hirst, Sara Tookey, Robert S. Kerrison, S Marshall, A Prentice, Daniel Vulkan, Stephen Duffy , Christian von Wagner (2020)Use of a GP-endorsed non-participant reminder letter to promote uptake of bowel scope screening: A randomised controlled trial in a hard-to-reach population, In: Preventive medicine141106268 Elsevier

Previous research suggests that sending non-participants a reminder letter, 1 year after their initial invitation, can improve coverage for bowel scope screening (BSS), also known as flexible sigmoidoscopy screening. We hypothesised that adding a general practitioner's (GPs) endorsement to the reminder letter could improve coverage even further. We conducted a randomised controlled trial in North West London, UK. Participants were screening-eligible men and women who had not responded to their initial BSS invitation at least 12 months prior to the trial period. Eligible adults were randomised in a 1:1 ratio to receive either a GP-endorsed reminder letter, or a standard reminder letter from June to August 2019. Logistic regression models were used to test the effect of the GP endorsement on attendance at BSS, adjusting for sex, clinical commissioning group, and local area socioeconomic deprivation. In total, 1200 participants were enrolled into the study and randomised to either the control (n = 600) or the intervention (n = 600) group. Those who received the GP-endorsed reminder letter were only slightly more likely to attend BSS than those who received the standard reminder letter (4% vs. 3%); this difference was not statistically significant (Adjusted OR = 1.30; 95% CI: 0.69, 2.43). Adding a GP-endorsement to the annual reminder letter did not have an effect on attendance at BSS. One possible explanation for this is that the endorsement used was not personalised enough. Future research should examine stronger GP-endorsements or other methods to promote uptake.

Robert S. Kerrison, Christian von Wagner , A Ghanouni, TJ Green, U Macleod, Mark Hughes, Colin Rees, Stephen Duffy , L McGregor (2020)Lessons Learned From Conducting a Rapid Review: A Case Study Examining Factors Associated With Flexible Sigmoidoscopy Screening Use, In: SAGE Research Methods Cases: Medicine and Health SAGE

Rapid reviews enable researchers to obtain a snapshot of what is known about a topic in a quick and systematic way, and are increasingly becoming an important aspect of the research literature. Despite this, there are currently no formal guidelines as to how best to conduct a rapid review. One method is to begin with a narrow search, and to expand the search successively, until the number of new/additional publications considered potentially eligible, based on title and abstract alone, is less than 1% of the total number of publications found overall (at this point, one can be reasonably confident that expanding the search is unlikely to yield any considerable new information). One of the main advantages of this method is that it provides a rationale for terminating the search at a given point, thereby making it less time-consuming than many other methods, which require the reviewer(s) to screen all articles found in response to a comprehensive list of search terms. In this case study, we describe our experience using the aforementioned method to review the literature investigating factors associated with flexible sigmoidoscopy (“bowel scope”) screening use, and the lessons learned from it. We also describe the problems encountered in performing our review, and the steps implemented to overcome them. Finally, we provide suggestions for methodological improvements for the benefit of those considering conducting a rapid review in the future.

Sandro Stoffel, Stala Kioupi, Despina Ioannou, Robert S. Kerrison, Christian von Wagner , Benedikt Herrmann (2021)Testing messages from behavioral economics to improve participation in a population-based colorectal cancer screening program in Cyprus Results from two randomized controlled trials, In: Preventive Medicine Reports24101499 Elsevier

Despite the benefits of colorectal cancer (CRC) screening, participation compares poorly to other screening programs. This study assessed the effectiveness of adding different behavioral economic-based messages, to the invitation letter, to increase uptake in the Cypriot CRC screening program. We performed two randomized controlled trials. In the first trial (‘Trial 1’), 3212 individuals, aged 50 to 69 years, were randomly allocated (1:1:1:1:1:1:1) to one of six intervention groups, or the control. The intervention groups received the standard invitation letter received by the control, with the addition of one of six messages based on the following behavioral economics principles: (1) social responsibility, (2) anticipated regret, (3) financial opportunity costs (of non-attendance), (4) benefit (of early detection), (5) scarcity effect (limited duration of the offer) and (6) social norms. The second trial (‘Trial 2’) tested the most efficacious message (social responsibility) against the control in a larger sample (N=3074). In both trials, the primary outcome was uptake eight weeks after the screening invitation. In trial 1, overall uptake was 20.6%. There were no significant differences between the control and the intervention conditions for the overall sample or men (all p’s>0.05). Highlighting the social consequences of cancer did, however, increase uptake rates among women (25.6% vs. 17.1%, aOR 1.67; 95% CI 1.05-2.66, p=0.031). We, therefore, tested this message in Trial 2. Uptake was similar to trial 1 with 20.7% (intervention: 20.8% vs control: 20.6%) and there was no impact on overall or uptake of men and women separately (all p’s>0.05).