Use of SMS text messaging and videos in bowel cancer screening

In Australia, a study (SMARTscreen) aimed to test whether a multi-intervention short message service (SMS) sent by general practices to 50–60-year-old patients who were due to receive the NBCSP (national bowel cancer screening programme) kit would increase NBCSP uptake, by comparing it with usual care (1):

• for intervention practices, people due to receive the NBCSP kit within a 6-month study period were sent an SMS just before receiving the kit
  • SMS included a personalised message from the person’s general practice endorsing the kit, a motivational narrative video, an instructional video, and a link to more information
  • control practices continued with usual care, comprising at-home testing with a faecal immunochemical test (FIT) through the NBCSP
    
    
• study results showed that:
  • 39.2% (1143/2914) of people in 11 intervention practices and 23.0% (583/2537) of people in 10 control practices had a FIT result in their electronic health records - a difference of 16.5% (95% confidence interval = 2.02 to 30.9)
  • note that it has been estimated that increasing screening participation by 10% could prevent 27 000 incident CRC diagnoses and 16 800 cancer deaths, and that an additional A$200 million expenditure could be saved over the next 20 years in the Australian population
    
    
• study authors concluded:
  • SMS intervention increased NBCSP kit return in 50–60-year-old patients in general practice

A US study investigated whether providing information on patient risk for advanced colorectal neoplasia (ACN; which includes CRC and advanced precancerous lesions) to patients and providers affects screening uptake, and to identify effect moderators (2):

• participants were randomly assigned to view a CRC screening decision aid with or without a personalized message about ACN risk. Providers were randomly assigned to receive notifications that the patient was due for screening, with or without a personalized message about the patient’s ACN risk
• participants - 214 providers and 1084 average-risk patients due for screening
• study results
  • overall, there were no differences in screening uptake or test completion for the provider notification (predicted probabilities, 41.5% vs. 36.4% for personalized vs. generic; difference, 5.1 [95% CI, −1.6 to 11.8] percentage points) or decision aid (predicted probabilities, 36.8% vs. 41.0% for personalized vs. generic; difference, −4.1 [CI, −10.2 to 1.9] percentage points) interventions
  • health system was an effect moderator for stool testing. For one health system, the stool testing rate was higher for personalized versus generic provider notification (predicted probabilities, 21.1% vs. 7.9%; difference, 13.2 [CI, 1.6 to 24.8] percentage points) when the decision aid was generic
  • the stool testing rate was higher for the personalized versus the generic decision aid (predicted probabilities, 21.4% vs. 7.9%; difference, 13.5 [CI, 2.4 to 24.5] percentage points) when the provider notification was generic
• the study authors concluded:
  • although including personalized risk for ACN in a decision aid or provider notification had no overall effect, it increased uptake of stool testing in one health system

Reference:

1. McIntosh JG et al. Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial. British Journal of General Practice 18 March 2024; BJGP.2023.0230. DOI: https://doi.org/10.3399/BJGP.2023.0230
2. Schwartz PH et al. et al. Effect of Personalized Risk Messages on Uptake of Colorectal Cancer Screening (https://www.acpjournals.org/doi/abs/10.7326/ANNALS-24-03144): A Randomized Controlled Trial. Ann Intern Med.[Epub 2 September 2025].