Abstract
BackgroundIn Scotland a new, easier to complete bowel screening test, the Faecal Immunochemical Test (FIT), has been introduced. This test gives more accurate information about an individual’s risk of having colorectal cancer (CRC), based on their age and gender, and could lead to fewer missed cancers compared to the current screening test. However, there is no evidence of the effect on colonoscopy uptake of providing individuals with personalised risk information following a positive FIT test.The objectives of the study are:To develop novel methods of presenting personalised risk information in an easy-to-understand format using infographics with involvement of members of the publicTo assess the impact of different presentations of risk information on informed choice and intention to take up an offer of colonoscopy after FITTo assess participants’ responses to receiving personal risk information (knowledge, attitudes to screening/risk, emotional responses including anxiety).MethodsAdults (age range 50–74) registered on the Scottish Bowel Screening database will be invited by letter to take part. Consenting participants will be randomised to one of three groups to receive hypothetical information about their risk of cancer, based on age, gender and faecal haemoglobin concentration: 1) personalised risk information in numeric form (e.g. 1 in 100) with use of infographics, 2) personalised information described as ‘highest’, ‘moderate’ or ‘lowest’ risk with use of infographics, and 3) as a ‘positive’ test result, as is current practice. Groups will be compared on informed choice, intention to have a colonoscopy, and satisfaction with their decision. Follow-up semi-structured qualitative interviews will be conducted, by telephone, with a small number of consenting participants (n = 10 per group) to explore the acceptability/readability and any potential negative impact of the risk information, participants’ understanding of risk factors, attitudes to the different scenarios, and reasons for reported intentions.DiscussionProving personalised risk information and allowing patient choice could lead to improved detection of CRC and increase patient satisfaction by facilitating informed choice over when/whether to undergo further invasive screening. However, we need to determine whether/how informed choice can be achieved and assess the potential impact on the colonoscopy service.Trial registrationThe trial is registered on www.isrctn.com on 08/12/2017. Registration no: ISRCTN14254582.
Highlights
In Scotland a new, easier to complete bowel screening test, the Faecal Immunochemical Test (FIT), has been introduced
Groups will be compared on informed choice, intention to have a colonoscopy, and satisfaction with their decision
Proving personalised risk information and allowing patient choice could lead to improved detection of colorectal cancer (CRC) and increase patient satisfaction by facilitating informed choice over when/whether to undergo further invasive screening
Summary
In Scotland a new, easier to complete bowel screening test, the Faecal Immunochemical Test (FIT), has been introduced. FIT (along with age/gender) could provide a more personalised risk of harbouring advanced neoplasia (colorectal cancer (CRC) or high risk adenoma), and empower people to make an informed decision about whether or not to undergo colonoscopy, by balancing the risks of the procedure (e.g. bleeding/bowel wall perforation) against the risk of missing a cancer. We aim to investigate the potential implications of providing the screened population with a more informed choice to help establish the impact on colonoscopy services
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