Simple Deadline Prompt Increases FIT Return Rates in Colorectal Cancer Screening

A large, randomized controlled trial embedded in the Scottish Bowel Screening Programme has shown that a brief, low-cost intervention—a suggested return deadline—significantly improves return rates of the faecal immunochemical test (FIT) for colorectal cancer screening as published in The Lancet. 

The TEMPO trial enrolled 40,000 adults aged 50–74 years and randomly assigned them to one of eight groups, testing combinations of a planning tool and deadline prompts of varying lengths. The primary outcome was the proportion of participants who returned a completed FIT within three months.

The control group, which received a standard invitation without a deadline or planning tool, had a 3-month FIT return rate of 66.0%. The highest return rate—68.0%—was observed in the group that received a 2-week deadline without the planning tool, a 2.0% absolute increase compared to the control (95% CI, 0.2 to 3.9). The lowest return rate, 63.2%, occurred in the group that received only the planning tool with no deadline.

The primary analysis showed a clear benefit from including a return deadline in the invitation letter. "The adjusted odds ratio for the effect of giving a deadline was 1.13 (95% CI, 1.08 to 1.19; p<0.0001)," the authors reported. In contrast, the planning tool had no positive effect on return rates (aOR 0.98; 95% CI, 0.94 to 1.02; p=0.34) and even appeared to reduce return rates when provided without a deadline (aOR 0.88; 95% CI, 0.81 to 0.96; p=0.0030).

Secondary analyses confirmed that the deadline intervention accelerated FIT returns, particularly near the suggested deadline, and reduced the need for reminder letters. “Adding a single sentence suggesting a deadline for FIT return… resulted in more timely FIT return and reduced the need to issue reminder letters,” the study concluded.

This trial demonstrates that a simple deadline prompt is an effective, scalable strategy to improve CRC screening uptake. In contrast, the use of a problem-solving planning tool showed no measurable benefit and may even hinder participation when used alone.

Reference
Robb KA, Young B, Murphy MK, et al. Behavioural interventions to increase uptake of FIT colorectal screening in Scotland (TEMPO): a nationwide, eight-arm, factorial, randomised controlled trial. The Lancet. March 2025. doi:10.1016/s0140-6736(24)02813-7