Deborah Cunningham

Are text message reminders an effective intervention to improve uptake of breast screening? A randomised controlled trial

Abstract Background Breast cancer is a major public health concern in the UK, one accounting for 16% of all cancer incidences and 7% of all cancer deaths. Fortunately, the natural history of this malignancy can be beneficially changed through the early detection and treatment of benign and malignant breast disease, which have been enabled by mammographic screening techniques. However, the success of screening programmes depends on their ability to attract the at-risk population, as well as the analytical specificity and sensitivity of the screening test itself. The NHS Breast Screening Programme attracts about three-quarters of the invited population each year. In 2010, all but one region reported a triennial coverage of more than 75%; London was the exception, reporting a regional coverage of 69%. London consistently fails to meet the national target. Missed appointments are a primary cause of inefficiency in health-care delivery, with adverse clinical implications for the non-attending patient and substantial monetary costs to the health service. To ensure the future success of the breast screening programme, development of strategies to improve uptake of hard-to-reach patients is imperative. Research has shown that receiving an appointment reminder by text message has been successful in reducing non-attendance in other areas of health care; the same might be true for breast screening. Our primary aim was to establish whether text message reminders can significantly improve the uptake of breast screening by women on an intention-to-treat basis in the London Borough of Hillingdon. Our secondary aim was to assess whether text message reminders are an effective intervention for improvement of uptake of breast screening by hard-to-reach patients such as women living in deprived areas and women of black and minority ethnic groups. Methods We undertook a single-blind, randomised controlled trial to assess the effectiveness of sending a text message appointment reminder 48 h before a patients first breast screening appointment to improve uptake of the programme by prevalent women aged 47–53 years in the London Borough of Hillingdon. 1640 women without a history of breast screening, implant, or bilateral mastectomy were included in the study and randomly assigned (1:1) to either the control (n=833) or intervention (n=807) group. Women in the control group were invited to screening but received no reminder for their appointment, whereas women in the intervention group received a text message reminder 48 h in advance. All women received an information letter about the study with their invitation from the West of London Breast Screening Service. Patients were not told whether they would be receiving a text message reminder or not. iPlato Patient Care Messaging was used to deliver text message reminders. This trial is registered with ClinicalTrials.gov, NCT01977599. Findings Women in the text message reminder group were significantly more likely (odds ratio 1·32, 95% CI 1·12–1·53; p=0·0092) to attend their first breast screening appointment (69% uptake) than women in the control group (63% uptake). Of the 807 women assigned to the text message reminder group, only 316 (39%) had a valid mobile telephone number recorded on the GP Clinical System and were subsequently able to receive a text message reminder. Of the 316 patients who did receive a text message reminder, 252 (80%) attended breast screening. No adverse events were reported. These are preliminary data of an ongoing trial expected to be completed in September, 2013. Full results including deprivation and ethnic origin data will be available for the conference. Interpretation Receipt of a text message reminder 48 h before a scheduled breast screening appointment significantly improves uptake. To ensure that the benefits of text message reminders are achieved, work is needed to improve patient mobile records. Funding Research funded by Imperial College Healthcare Charity.

A clinical "near miss" highlights risk management issues surrounding ultrasound-guided and wire-localised breast resections

BackgroundThe introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure.Case reportA case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence.ConclusionIt is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.

Best-practice care pathway for improving management of mastitis and breast abscess: Management of mastitis and breast abscess

Surgical subspecialization has resulted in mastitis and breast abscesses being managed with unnecessary admission to hospital, prolonged inpatient stay, variable antibiotic prescribing, incision and drainage rather than percutaneous aspiration, and loss to specialist follow‐up. The objective was to evaluate a best‐practice algorithm with the aim of improving management of mastitis and breast abscesses across a multisite NHS Trust. The focus was on uniformity of antibiotic prescribing, ultrasound assessment, admission rates, length of hospital stay, intervention by aspiration or incision and drainage, and specialist follow‐up.