Abstract
BackgroundIn Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, however, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive.This paper describes the development and optimisation of a Colorectal cancer RISk Prediction tool (‘CRISP’) for use in primary care. The aim of the CRISP tool is to increase risk-appropriate CRC screening.MethodsCRISP development was informed by previous experience with developing risk tools for use in primary care and a systematic review of the evidence. A CRISP prototype was used in simulated consultations by general practitioners (GPs) with actors as patients. GPs were interviewed to explore their experience of using CRISP, and practice nurses (PNs) and practice managers (PMs) were interviewed after a demonstration of CRISP. Transcribed interviews and video footage of the ‘consultations’ were qualitatively analyzed. Themes arising from the data were mapped onto Normalization Process Theory (NPT).ResultsFourteen GPs, nine PNs and six PMs were recruited from 12 clinics. Results were described using the four constructs of NPT: 1) Coherence: Clinicians understood the rationale behind CRISP, particularly since they were familiar with using risk tools for other conditions; 2) Cognitive participation: GPs welcomed the opportunity CRISP provided to discuss healthy and unhealthy behaviors with their patients, but many GPs challenged the screening recommendation generated by CRISP; 3) Collective Action: CRISP disrupted clinician-patient flow if the GP was less comfortable with computers. GP consultation time was a major implementation barrier and overall consensus was that PNs have more capacity and time to use CRISP effectively; 4) Reflexive monitoring: Limited systematic monitoring of new interventions is a potential barrier to the sustainable embedding of CRISP.ConclusionsCRISP has the potential to improve risk-appropriate CRC screening in primary care but was considered more likely to be successfully implemented as a nurse-led intervention.
Highlights
In Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive
In Australia, the National Health and Medical Research Council (NHMRC) guidelines recommend the non-invasive and inexpensive fecal occult blood test (FOBT), using the fecal immunochemical test (FIT), for screening in people at average risk of CRC, and more invasive and expensive colonoscopy only for those who are at increased risk, with risk-stratification based on age and family history criteria [3]
4. as a result of our findings on General practitioner (GP)’ perceptions about the relative benefits and harms of FOBT and colonoscopy, we developed additional risk communication output in cancer RISk Prediction tool (CRISP) to highlight the potential harms of colonoscopy and the sensitivity of FOBT to detect CRC using ‘expected frequency trees’ (Fig. 7) [16]
Summary
In Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive. In Australia, the National Health and Medical Research Council (NHMRC) guidelines recommend the non-invasive and inexpensive fecal occult blood test (FOBT), using the fecal immunochemical test (FIT), for screening in people at average risk of CRC, and more invasive and expensive colonoscopy only for those who are at increased risk, with risk-stratification based on age and family history criteria [3]. Risk-stratified screening requires valid risk prediction models that accurately discriminate people at increased risk from those who are not. These risk models require easy-to-use risk assessment tools for implementation into clinical practice [7]. Several had undergone limited clinical evaluation prior to testing in a full scale randomized controlled trial (RCT), contrary to recommendations about the development and evaluation of complex interventions [9, 10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
