A comparison of different strategies used to invite subjects with a positive faecal occult blood test to a colonoscopy assessment. A randomised controlled trial in population-based screening programmes

•We compared compliance with different strategies used to invite FIT + subjects for a colonoscopy.•Compliance with initial invitations by mail and by phone was similar.•The best strategy for recalling non-compliers was a meeting with a specialist screening practitioner.•Compliance with total colonoscopy did not increase with a GP's involvement.

ObjectiveThe purpose of this parallel randomised controlled trial was to compare compliance with different modalities used to invite patients with a positive immunochemical faecal occult blood test (FIT +) for a total colonoscopy (TC).MethodFIT + patients from nine Italian colorectal cancer screening programmes were randomised to be invited for a TC initially by mail or by phone and, for non-compliers, to be recalled by mail, for counselling with a general practitioner, or to meet with a specialist screening practitioner (nurse or healthcare assistant).ResultsIn all, 3777 patients were randomised to different invitation strategies. Compliance with an initial invitation by mail and by phone was similar (86.0% vs. 84.0%, relative risk — RR: 1.02; 95%CI 0.97–1.08). Among non-responders to the initial invitation, compliance with a recall by appointment with a specialist practitioner was 50.4%, significantly higher than with a mail recall (38.1%; RR:1.33; 95%CI 1.01–1.76) or with a face-to-face counselling with the GP (30.8%; RR:1.45;95%CI 1.14–1.87).ConclusionCompliance with an initial invitation for a TC by mail and by phone was similar. A personal meeting with a specialist screening practitioner was associated with the highest compliance among non-compliers with initial invitations, while the involvement of GPs in this particular activity seemed less effective.