Bowel cancer isn’t a subject anyone wants to think about or talk about – but turning a blind eye leaves people at risk of developing the disease. As reported by the BBC, more than 16,000 people die in the UK of bowel cancer every year and it is the second biggest cancer killer in the UK.

The good news is that – thanks to early diagnosis and better treatment – this number has been in decline since the 1970s.

With bowel scope screenings so pivotal in detecting cancer in its early stages, there is a drive to encourage more people to attend bowel scope testing for free by the NHS – although the Covid-19 pandemic has altered those plans.

In this case study we’ll look at how Snap Surveys played a part in improving bowel cancer screenings thanks to both paper and web-based surveys.

Bowel Cancer Screening

Each year, more than 42,000 people are diagnosed with bowel cancer in the UK – with around 268,000 people currently living with the disease. Fortunately, when diagnosed early, bowel cancer is much easier to treat and has a very high survival rate.

Who is at risk?

Over 94% of new cases are diagnosed in people over the age of 50, with 59% of new cases seen in people over the age of 70 (Bowel Cancer UK). Due to its high survival rate when detected early, the NHS invites people over the age of 60 in those demographics to regular screenings.

Over 10,000 lives are saved every year through early diagnosis (NHS England).

Improving screening uptake

Unfortunately, bowel cancer has the lowest uptake rate of any cancer screening – with just 66% of those invited actually attending a screening.

Health Behaviour Research Centre at UCL is working with NHS Bowel Screening Programme to evaluate people’s experiences. Dr Christian von Wager leads the research team and needed Snap Surveys’ expertise in high-volume survey processing.

How Snap Surveys got involved

Initial surveys

As the NHS relies on patient feedback to continually improve the level of care it provides, Snap Surveys worked with UCL to print and distribute paper surveys. Patients received questionnaire packs on the day of their screening and were asked to fill them in the next day. Each pack contained a free-post envelope to boost the response rates.

Over 150,000 questionnaire packs were printed and distributed to 64 sites that conducted screenings, generating 71,865 responses which the Snap Surveys Projects team keyed in manually.

Within the survey they were asked to provide contact details if they were happy to conduct a follow-up survey in three months’ time.

Follow-up surveys

These follow-up surveys were initially sent by email (as this is a cost effective method once contact details and consent has been established) but also included paper surveys where appropriate.

The paper surveys generated exceedingly high response rates, with 14,986 responses out of 17,500 surveys distributed. This gave us a response rate of 85.6% from paper. We also received 15,439 responses from 31,000 emails, giving us a 49.8% response rate for web.

The strategy of using paper surveys on the day, with a combination of paper and email surveys for the follow-up, proved to be successful in securing feedback from patients. Initial questions included people’s feelings about the screening beforehand, preferred gender of the doctor performing the test, pleasantness of the screening and whether they felt any pain during or after screening was complete.

The follow-up focused on feeling around the level of care they received, including privacy and dignity, plus whether any problems were encountered in the months after the test.

Data security

Unique reference numbers were used to pair initial responses with follow-up surveys, ensuring patients’ data was anonymous. As Snap Surveys is ISO 27001 certified and GDPR compliant, we handle all data safely and securely in the UK.

The outcome

Response rate

Out of 182,939 surveys distributed via paper and online, we collected a final total of 102,290 responses.

Overall, this gave us a very satisfying response rate of 55.9%.

How responses would be used by UCL and the NHS

Responses were looked at a screening centre level, helping the individual teams to identify areas for improvement as well as what they were doing well. Teams would meet to discuss changes they could make to the services based on the feedback.

For example, if a pain score indicated that people felt the procedure was more painful than they expected, a local change may be that all patients are shown how to use the entenox before the procedure begins.

Patient information and leaflets were also updated and improved following the feedback.

Each team made minor adjustments where needed based on the feedback to improve services, hoping to boost future participation rates and ultimately save lives.

Customer feedback

“The team from the Department of Behavioural Science and Health at UCL was extremely pleased to lead the development of the patient questionnaire and evaluate the data returned by Snap Surveys. We used the data to feed back to individual centres on a monthly basis. We always received great feedback from centres who valued the information and were able to reflect on their service through this regular feedback. We were also pleased to disseminate findings via national conferences.”
Dr Christian Von Wagner, UCL