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The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial

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Abstract

Purpose

The purpose of the study was to investigate whether fecal occult blood test (FOBT) home-delivery and individual education or combined with family education increases FOBT uptake rates in Singapore.

Methods

This is a randomized controlled intervention study of Singaporean residents aged 50 years and above, conducted in May 2012 till May 2013. Eligible individuals in randomly selected households were screened, and one member was randomly selected and allocated to one of the four arms: Group A (individual and family education, FOBT kits provided), Group B (individual education only, FOBT kits provided), Group C (no education, FOBT kits provided) and Group D (no education or FOBT kits provided).

Results

Overall response rate was 74.7 %. The FOBT return rates for groups A, B, C and D were 24.5 % [CI 16.2–34.4 %], 25.3 % [CI 16.4–36.0 %], 10.7 % [CI 4.7–19.9 %] and 2.2 % [CI 0.3–7.7 %], respectively. Respondents who were provided education and home-delivered FOBT kits were 15 times more likely to return FOBT kits [Group A: OR 15.0 (3.4–66.2); Group B: OR 15.5 (3.5–68.8)] and those provided with home-delivered FOBT without education were five times more likely to return FOBT kits [Group C: OR 5.8 (1.2–28.3)] than those without education and FOBT kits (Group D). There was no significant difference in return of FOBT kits whether education was provided to subject with or without a family member.

Conclusion

Home delivery of FOBT kits increased FOBT return rates and individual education combined with home-delivered FOBT increased FOBT return rates even further. However, additional combination with family education did not increase FOBT rates further.

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References

  1. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18(3):581–592

    Article  PubMed  CAS  Google Scholar 

  2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics. CA Cancer J Clin 59(4):225–249

    Article  PubMed  Google Scholar 

  3. Ministry of Health (2011) Ministry of health: principle causes of death. http://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Principal_Causes_of_Death.html. Accessed 11 Sept 2013

  4. Singapore Cancer Registry (2010) Interim report trends in cancer incidence in Singapore 2004–2008. Singapore Cancer Registry

  5. Towler B, Irwig L, Glasziou P, Kewenter J, Weller D, Silagy C (1998) A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. BMJ 317(7158):559–565

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Pignone M, Rich M, Teutsh SM, Berg AO, Lohr KN (2002) Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med 137(2):132–141

    Article  PubMed  Google Scholar 

  7. Pignone M, Saha S, Hoerger T, Mandelblatt J (2002) Cost-effective analyses of colorectal cancer screening: a systematic review for the U.S. preventive services task force. Ann Intern Med 137(2):96–104

    Article  PubMed  Google Scholar 

  8. Atkin W (1999) Implementing screening for colorectal cancer. BMJ 319(7219):1212–1213

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  9. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008) Cochrane systematic review of colorectal screening using the fecal occult blood test (haemoccult): an update. Am J Gastroenterol 103(6):1541–1549

    Article  PubMed  Google Scholar 

  10. Gellad ZF, Provenzale D (2010) Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology 138(6):2177–2190

    Article  PubMed  Google Scholar 

  11. National Health Survey 2010 (2011) Epidemiology and Disease Control Division, Ministry of Health (MOH) Singapore

  12. UK Colorectal Cancer Screening Pilot Group (2004) Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom. BMJ 329:133–135

    Article  PubMed Central  Google Scholar 

  13. Ellis RJB, Wilson S, Holder RL, McManus RJ (2007) Different faecal sampling methods alter the acceptability of faecal occult blood testing: a cross sectional community survey. Eur J Cancer 43(9):1437–1444

    Article  PubMed  Google Scholar 

  14. Wong NY, Nenny S, Guy RJ, Seow-Choen F (2002) Adults in a high risk area are unaware of the importance of colorectal cancer. Dis Colon Rectum 45(7):946–954

    Article  PubMed  CAS  Google Scholar 

  15. Seeff LC, Nadel MR, Klabunde CN, Thompson T, Shapiro JA, Vernon SW, Coates RJ (2004) Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer 100(10):2093–2103

    Article  PubMed  Google Scholar 

  16. Ata A, Elzey JD, Insaf TZ, Grau AM, Stain SC, Ahmed NU (2006) Colorectal cancer prevention: adherence patterns and correlates of tests done for screening purposes within United States populations. Cancer Detect Prev 30:134–143

    Article  PubMed  Google Scholar 

  17. Ng ES, Tan CH, Teo DCL, Seah CYE, Phua KH (2007) Knowledge and perceptions regarding colorectal cancer screening among Chinese—a community-based survey in Singapore. Prev Med 45(5):322–325

    Article  Google Scholar 

  18. Seow A, Huang J, Straughan PT (2000) Effects of social support, regular physician and health-related attitudes on cervical cancer screening in an Asian population. Cancer Causes Control 11(3):223–230

    Article  PubMed  CAS  Google Scholar 

  19. Stokamer CL, Tenner CT, Chaudhuri J, Vazquez E, Bini EJ (2005) Randomized controlled trial of the impact of intensive patient education on compliance with fecal occult blood testing. J Gen Intern Med 20:278–282

    Article  PubMed  PubMed Central  Google Scholar 

  20. Foo AS, Thia JJP, Ng ZP, Fong NP, Koh GCH et al (2011) Colorectal cancer screening: the effectiveness of education on its barriers and acceptability. Asia Pac J Public Health 24(4):595–609

    Article  PubMed  Google Scholar 

  21. Ministry of Health, Singapore (2003) Health screening: clinical practice guidelines. Ministry of Health, Singapore

    Google Scholar 

  22. Ministry of Health, Singapore (2010) Cancer screening: MOH clinical practice guidelines. Ministry of Health, Singapore

    Google Scholar 

  23. Kish LA (1949) Procedure for objective respondent selection within the household. J Am Stat Assoc 44(247):380–387

    Article  Google Scholar 

  24. Department of Economic and Social Affairs Statistic Division (2008) Designing household survey samples: practical guidelines. United Nations Publications Series F: No. 98

  25. Holden DJ, Jonas DE, Porterfield DS, Reuland D, Harris R (2010) Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med 152(10):668–676

    Article  PubMed  Google Scholar 

  26. Wee LE, Koh GCH (2011) The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: a controlled intervention study. Prev Med 53(1–2):64–69

    Article  PubMed  Google Scholar 

  27. Wong RK, Wong ML, Chan YH, Feng Z, Wai CT, Yeoh KG (2013) Gender differences in predictors of colorectal cancer screening uptake: a national cross sectional study based on the health belief model. BMC Public Health 13(1):677

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tinmouth J, Ritvo P, McGregor SE, Claus D, Pasut G, Myers RE, Guglietti C, Paszat LF, Hilsden RJ, Rabeneck L (2011) A qualitative evaluation of strategies to increase colorectal cancer screening uptake. Can Fam Phys 57(1):e7–e15

    Google Scholar 

  29. Tinmouth J, Baxter NN, Paszat LF, Rabeneck L, Sutradhar R, Yun L (2014) Using physician-linked mailed invitations in an organised colorectal cancer screening programme: effectiveness and factors associated with response. BMJ Open 4(3):2013–004494

    Article  Google Scholar 

  30. Bapuji SB, Lobchuk MM, McClement SE, Sisler JJ, Katz A, Martens P (2012) Fecal occult blood testing instructions and impact on patient adherence. Cancer Epidemiol 36(4):e258–e264

    Article  PubMed  Google Scholar 

  31. Church TR, Yeazel MW, Jones RM, Kochevar LK, Watt GD, Mongin SJ, Cordes JE, Engelhard D (2004) A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening. J Natl Cancer Inst 96(10):770–780

    Article  PubMed  Google Scholar 

  32. Ouakrim DA, Lockett T, Boussioutas A, Keogh L, Flander LB, Hopper JL, Jenkins MA (2013) Screening participation predictors for people at familial risk of colorectal cancer: a systematic review. Am J Prev Med 44(5):496–506

    Article  Google Scholar 

  33. Baron RC, Rimer BK, Breslow RA, Coates RJ, Kerner J, Melillo S, Habarta N, Kalra GP, Chattopadhyay S, Wilson KM, Lee NC, Mullen PD, Coughlin SS, Briss PA (2008) Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening: a systematic review. Am J Prev Med 35:002

    Google Scholar 

  34. Rees CJ, Bevan R (2013) The national health service bowel cancer screening program: the early years. Expert Rev Gastroenterol Hepatol 7(5):421–437

    Article  PubMed  CAS  Google Scholar 

  35. Institute of Medicine US (2001) Committee on health and behavior: research, practice, and policy. Health and behavior: the interplay of biological, behavioral, and societal influences. National Academies Press US; 5, Individuals and families: models and interventions. Washington, DC. http://www.ncbi.nlm.nih.gov/books/NBK43749/. Assessed 16 Sept 2013

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Acknowledgments

We thank Ms. Ong Whee Sze for her significant contribution in sampling and statistical support. Also, staff at Department of Statistics Singapore for providing us the samples from customized sampling frame, the pool of interviewers for their hard work, Madam Alice Poh and Ms. Wendy Ong Yong Siew as our part-time staff who assisted us throughout the project. We would like to also thank the Singapore Cancer Society for their generous contribution in providing FOBT kits and the necessary logistical support. This work was funded by the National Cancer Centre Research Fund. The funding body has no role in study design; in the collection, analysis, and interpretation of data; in writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All authors declare that there is no conflict of interests.

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Correspondence to Tam Cam Ha.

Appendices

Appendix 1: CRC Screening Form

figure a

Appendix 2: CRC Screening Knowledge Questionnaire

figure b
figure c
figure d

Appendix 3: Standardized education package for CRC screening administered using iPad

Outline in presentation

Information provided

What is CRC?

Cancer of the large intestine (colon and rectum)

In Singapore, most common cancer among men and second most common among women

8,206 new cases (2006–2010)

At risk of CRC:

 50 years and above

 Diet high in fat and low dietary fiber

 Sedentary lifestyle and obese

Importance of screening

Detect cancer early even though no symptoms

Detect early, better chance of cure

Less complications in treatment

Less medical costs

Recommended frequency of screening

Average-risk individuals, beginning at the age of 50 years

Once a year for FOBT (fecal occult blood testing)

What is the FOBT

Showing what the kit looks like graphically

Contents of FOBT pack

Showing the contents of FOBT graphically

Using of FOBT kits for collection of stool sample

Using step-by-step picture guide from the Singapore Cancer Society and Health Promotion board to illustrate in this section

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Ha, T.C., Yong, S.K., Yeoh, KW. et al. The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial. Cancer Causes Control 25, 1473–1488 (2014). https://doi.org/10.1007/s10552-014-0449-4

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  • DOI: https://doi.org/10.1007/s10552-014-0449-4

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