Bowel

Improvement activity for bowel screening could be focused on the following core activities:

• Understanding what the barriers to screening are for different population groups e.g. in respect to learning disabilities, physical disabilities, cultural beliefs, health literacy and access.
• Undertaking audit or review to identify your practice’s core underserved populations and non-responder groups.
• Adopting GP endorsement of bowel screening as standard practice.
• Target interventions to follow up specific non-responders e.g. people with learning disabilities, SMI, physical disabilities, living in high deprived areas, of working age and BAME.
• For patients who are non-responders, ordering another kit on their behalf with their consent and expressed intention to complete test.
• Sharing the bowel screening helpline with patients who wish to order a kit, if eligible. Helpline number 0800 707 6060.
• Priming communications and support for first time invitees in underserved population groups.
• Addressing known screening inequalities by supporting both national and regional initiatives to improve screening uptake, including awareness raising campaigns.

Understanding the barriers to participation and underserved groups

National charities such as Cancer Research UK and Bowel Cancer UK have done extensive research reviews to identify the barriers to participation and underserved groups.

Evidence shows some of the common barriers are:

• Fear and denial around the test outcomes.
• A misconception that the test is for people with symptoms of bowel cancer.
• Concerns around the practicalities and cleanliness of the test.
• Low individual risk perception.
• Difficulty accessing information on the test or bowel cancer due to low health literacy and/or language barriers.

Lower participation groups

Whilst there are some national gaps in data and evidence, the following groups are less likely to participate in bowel screening:

• People from areas of higher deprivation or lower socio-economic status.
• Men.
• Younger eligible men.
• First-time invitees.
• People from non-white ethnic communities.
• People of certain religion e.g. Hindus, Muslims, Sikhs.
• People with disabilities.
• People with severe mental illness.
• Previous non-responders.

PCN and practice-based quality improvements could seek to target one of these population groups following a review of their own screening coverage data and a deeper dive into under-represented groups.

Data

Bowel screening data can be found on 👉 OHID Fingertips. Extracting data from the practices own clinical system helps to baseline and track the impact of improvement activities.

Cancer Research UK has developed a 👉 local bowel screening tool which enables practices to understand how their screening coverage compares to predicted levels based on socio-demographics.