Compliance, Patient Clinical Trial
Official title:
The Effectiveness of Telephone Reminders by a Layperson on Compliance With Colorectal Cancer Screening: an Open-label, Randomized Controlled Trial
This is a randomized controlled study to compare the effectiveness of interactive telephone reminders by a layperson on enhancing compliance with CRC screening by FOBT, when compared with usual care (i.e. no intervention).
Colorectal cancer (CRC) is one of the major global health challenges. CRC is currently the
third most common cancer in men and the second common in women worldwide, accounting for
approximately 10% of all cancers. It leads to 8% of all cancer mortality in the world and it
is the fourth most common cause of cancer deaths. There were 4,563 new cases and 3,893 new
deaths in Hong Kong in 2012, while 47.4% of the new cases were diagnosed at stage III or
above. In the past decades the Asia Pacific countries like China, South Korea, Japan, and
Singapore have witnessed a two to three-fold rise in incidence, gradually catching up the
figures in Western countries. The direct medical cost for the care of colorectal neoplasia
was estimated US$45,115 for stage IV CRC in the initial year of care, bringing a substantial,
global public health burden to the healthcare systems.
Randomized controlled studies have shown that CRC screening using Faecal Occult Blood Testing
(FOBT) is effective in reducing cancer mortality by 15-33%. FOBT as a quick office-based
procedure has the advantages of being non-invasive, inexpensive, acceptable, feasible,
patient-friendly and devoid of needs for bowel preparation. A 25% relative risk reduction in
CRC mortality was found for those attending at least one round of FOBT screening, according
to a systematic review conducted in 2007. Guidelines from the US Preventive Services Task
Force, the European Nations, the Asia Pacific Consensus statements and other authorities
recommended FOBT as one of the first-line screening modalities, especially in
resource-limited regions. Since yearly testing is recommended to maintain programmatic
effectiveness, longitudinal adherence is a critical component of FOBT-based screening
programs. Our previous study conducted in Hong Kong showed that the rate of compliance with
CRC screening was declining since the first year of enrolment.
Nevertheless, it remains unknown whether interventions based on reminder systems could
effectively enhance longitudinal compliance with FOBT, especially among those who have
already enrolled in a CRC screening programme. Current evidence does not adequately compare
whether interactive reminder are superior to usual care (i.e. no reminders).
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