CRC Screening invitation is sent Text-message Reminders In Colorectal Cancer Screening (TRICCS): A Non-clinical Randomised Controlled Trial Yasemin Hirst1, Hanna Skrobanski1, Robert Kerrison1, Lindsay C Kobayashi2, Nicholas Counsell3, Natasha Djedovic4, Josephine Ruwende5, Mark Stewart4, Christian von Wagner1 1 Health Behaviour Research Centre, UCL, London, UK 2 Harward T. H. Chan School of Public Health , Cambridge, US, 3 UCL Cancer Trials Centre, UCL, London, UK 4 London North West Healthcare NHS Trust, London,UK 5 NHS England London Region, London, UK Methods CRC Screening invitation is sent [Usual Care] N=8269 Background Results Colorectal Cancer (CRC) 4th most common cancer in the UK. In England, adults aged 60–74 years are eligible for colorectal cancer screening using a guaiac faecal occult blood test (gFOBt) kit Screening uptake at first time invitation is 54% (von Wagner et al., 2011) Multi-component reminders are effective to improve CRC uptake (usual care: 37% vs postal + phone + text reminder: 82%, Baker et al., 2014) Text-messages are often considered to be the next best alternative to telephone reminders, as they have the advantage of providing instant and direct transmission at a low cost Intention-to-treat: Uptake did not differ significantly between groups for the whole population of older adults (odds ratio [OR] 1·03, 95% confidence interval [CI] 0·94–1·12; p=0·56), but did vary between groups for first-time invitees (uptake was 35% in the control and 41% in the intervention; OR 1·29, 95% CI 1·04–1·58; p=0·02). WEEK 1 OR=1.29 CI (1.04-1.58), p=0.02 OR=0. 98 CI (89-1.08) p=0.66 gFOBt kit dispatched [Usual Care] Aims The primary aim of this RCT was to test the effectiveness of a text-message reminder to increase gFOBt uptake. Secondary aims were to examine between group differences for first-time invitees and to establish the efficacy of the text-message reminder to increase gFOBt uptake on a per-protocol basis (limited to individuals who have not returned their kit within 8 weeks and had a registered mobile number on their GPs Clinical System) Methods WEEK 5 Table 2. Mobile phone coverage among 141 GPs (Both study groups included)   % (N) OR (95% CI) p-value  Total 49.4 (N=4089) Gender Female 48.4 (n=2079) Ref Male 50.6 (n=2010) 1.08 (.99-1.18) .09 Age 60-64 53.6 (n=1972) <.001 65-69 49.2 (n=1213) .85 (.77-.95) .004 70-74 42.6 (n=904) .67 (.59-.75) IMD Quintile 1 42.7 (n=301) Quintile 2 40.7 (n=471) 1.24 (1.01-1.51) 0.04 Quintile 3 50.2 (n=1026) 1.61 (1.34-1.93) Quintile 4 51.7 (n=1316) 1.62 (1.36-1.94) Quintile 5 53.3 (n=920) 1.67 (1.39-2.02) CCG Croydon 61.9 (n=1109) Greenwich 56.1 (n=960) .79 (.68-.90) .001 Hammersmith &Fulham 32.2 (n=186) .29 (.24-.36) Hounslow 36.2 (n=595) .35 (.30-.41) Lewisham 58.1 (n=784) .81 (.70-.95) .007 West London 38.1 (n=455) .38 (.32-.44) We performed a randomised controlled trial across 141 general practices in London. Screening-eligible adults (n=8269) were randomised in a 1:1 ratio to receive either a text-message reminder [INTERVENTION] or no text-message reminder [CONTROL] if they had not returned their faecal occult blood test kit within eight weeks of initial invitation. (Hirst et al., 2016) The primary outcome was the proportion of adults returning a test kit at the end of an 18-week screening episode. The data were analysed on an intention-to-treat basis using logistic regression. A subgroup analysis was conducted for individuals receiving an invitation for the first time. Reminder Letter [Usual Care] Randomisation (1:1) n=8269 Control [Usual Care] (n=4135) Intervention [Text-reminder] (n=4134) WEEK 8 Results Table 1. Sample Characteristics  % (N) Uptake (%) Total 100.0 (n=8269) 40.0  Gender Male 48.0 (n=3973) 42.8 Female 52.0 (n=4296) 37.4 Age 60-64 44.5 (n=3682) 38.2 65-69 29.8 (n=2466) 40.9 70-74 25.7 (n=2121)  IMD (Index of Multiple Deprivation) Quintile 1 (Least Deprived) 8.6 (n=705) 51.5 Quintile 2 14.1 (n=1157) 41.9 Quintile 3 25.0 (n=2044) 43.4 Quintile 4 31.1 (n=2544) 38.0 Quintile 5 (Most Deprived) 21.1 (n=1727) 34.0 CCG (Clinical Commissioning Group) Croydon 21.7 (n=1791) 47.1 Greenwich 20.7 (n=1712) 43.3 Hammersmith &Fulham 7.0 (n=577) 35.9 Hounslow 19.9 (n=1645) 40.1 Lewisham 16.3 (n=1349) 37.5 West London 14.5 (n=1195) 30.5 Invitation Status First-time invitees 18.6 (n=1542) Repeat invitees 81.4 (n=6727) 40.8 Among 1393 people in the intervention group with a registered mobile and no returned kit, 73.4 % (n=1023) successfully received their reminders on the eighth week of their screening episode. The successful delivery of text-messages did not differentiate by participating CCGs (p=0.08), age group (p=0.09), gender (p=0.45), or IMD quintile (p=0.41) and invitation status (p=0.07). Eligible for a text-reminder n=1393 Received text-reminder n=1023 Undelivered messages n=370 Conclusion Although text-message reminders did not significantly increase uptake of the overall population, the improvement among first-time invitees is encouraging. 40% (1648 / 4135) 41% (1674 / 4134) WEEK 18 Intention to treat: [OR] 1·03, 95% [CI] 0·94–1·12; p=0·56 References Baker DW, Brown T, Buchanan DR, Weil J, Balsley K, Ranalli L, Lee JY, Cameron KA, Ferreira MR, Stephens Q, Goldman SN (2014) Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA intern Med 174(8): 1235-1241. Hirst, Y., Kerrison, R., Kobayashi, L. C., Counsell, N., Djedovic, N., Ruwende, J., … von Wagner, C. (2016). Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial. BMC Public Health, 16(1), 74. von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, Obichere A, Handley G, Logan RF, Rainbow S, Smith S, Halloran S, Wardle J (2011) Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol 40(3): 712-718