Which Test Is Best? A Cluster-Randomized Controlled Trial of a Risk Calculator and Recommendations on Colorectal Cancer Screening Behaviour in General Practice

Introduction: This cluster-randomized controlled trial aimed to assess the effect of the “Which test is best?” tool on risk-appropriate screening (RAS) and colorectal cancer (CRC) screening uptake. Methods: General practices in Sydney and Melbourne, Australia, and a random sub-sample of 460 patients (aged 25–74 years) per practice were invited by post. Clusters were computer randomized independently of the researchers to an online CRC risk calculator with risk-based recommendations versus usual care. Primary and secondary outcomes were RAS and screening uptake via self-reported 5-year screening behaviour after 12 months follow-up. The usual care group (UCG) also self-reported 5-year CRC screening behaviour at 12 month post-randomization. Results: Fifty-six practices were randomized (27 to the intervention and 29 to the control, 55 practices participated) with 818 intervention and 677 controls completing the primary outcome measure. The intervention significantly increased RAS in high-risk participants compared with UCG (80.0% vs. 64.0%, respectively; OR = 3.14, 95% CI: 1.25–7.96) but not in average-risk (44.9% vs. 49.5%, respectively; OR = 0.97, 95% CI: 0.99–1.12) or moderate-risk individuals (67.9% vs. 81.1%, respectively; OR = 0.40, 95% CI: 0.12–1.33). Faecal occult blood testing uptake over 12 months was increased compared with the UCG (24.9% vs. 15.1%; adjusted OR = 1.66, 95% CI: 1.24–2.22), and there was a non-significant increase in colonoscopies during the same period (16.6% vs. 12.2%; adjusted OR = 1.42, 95% CI: 0.97–2.08). Conclusion: An online CRC risk calculator with risk-based screening recommendations increased RAS in high-risk participants and improved screening uptake overall within a 12-month follow-up period. Such tools may be useful for facilitating the uptake of risk-based screening guidelines.

[1]  S. Rosso,et al.  Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. , 2021, The Lancet. Oncology.

[2]  I. Tomlinson,et al.  Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG) , 2019, Gut.

[3]  J. Emery,et al.  Family history–based colorectal cancer screening in Australia: A modelling study of the costs, benefits, and harms of different participation scenarios , 2018, PLoS medicine.

[4]  C. Oldmeadow,et al.  Prevalence of appropriate colorectal cancer screening and preferences for receiving screening advice among people attending outpatient clinics , 2018, Australian and New Zealand journal of public health.

[5]  J. Emery,et al.  Evaluation of the benefits, harms and cost‐effectiveness of potential alternatives to iFOBT testing for colorectal cancer screening in Australia , 2018, International journal of cancer.

[6]  P. Bampton,et al.  A nurse‐led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines , 2018, The Medical journal of Australia.

[7]  N. Corsini,et al.  Faecal occult blood testing (FOBT)-based colorectal cancer screening trends and predictors of non-use: findings from the South Australian setting and implications for increasing FOBT uptake. , 2017, Australian health review : a publication of the Australian Hospital Association.

[8]  G. Young.  Clinical practice guidelines for the prevention, early detection and management of colorectal cancer , 2018 .

[9]  G. Bobashev,et al.  Personalized medicine for prevention: can risk stratified screening decrease colorectal cancer mortality at an acceptable cost? , 2017, Cancer Causes & Control.

[10]  Georgiy Bobashev,et al.  Personalized medicine for prevention: can risk stratified screening decrease colorectal cancer mortality at an acceptable cost? , 2017, Cancer Causes & Control.

[11]  R. Sanson-Fisher,et al.  Improving adherence to colorectal cancer surveillance guidelines: results of a randomised controlled trial , 2017, BMC Cancer.

[12]  Jon Emery,et al.  The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care , 2017, BMC Medical Informatics and Decision Making.

[13]  Elissa V. Klinger,et al.  A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care. , 2017, American journal of preventive medicine.

[14]  D. Campbell-Scherer,et al.  Assessing family history of chronic disease in primary care: Prevalence, documentation, and appropriate screening. , 2017, Canadian family physician Medecin de famille canadien.

[15]  R. Sanson-Fisher,et al.  Can a print‐based intervention increase screening for first degree relatives of people with colorectal cancer? A randomised controlled trial , 2016, Australian and New Zealand journal of public health.

[16]  M. Phipps,et al.  Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. , 2016, JAMA.

[17]  P. Torán,et al.  Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care. , 2016, The British journal of general practice : the journal of the Royal College of General Practitioners.

[18]  C. V. D. van der Vleuten,et al.  How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs' communication strategies. , 2016, Family practice.

[19]  Swati G. Patel,et al.  Knowledge and Uptake of Genetic Counseling and Colonoscopic Screening Among Individuals at Increased Risk for Lynch Syndrome and their Endoscopists from the Family Health Promotion Project , 2016, The American Journal of Gastroenterology.

[20]  E. Halm,et al.  Impact of Risk Assessment and Tailored versus Nontailored Risk Information on Colorectal Cancer Testing in Primary Care: A Randomized Controlled Trial , 2015, Cancer Epidemiology, Biomarkers & Prevention.

[21]  C. Mathers,et al.  Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012 , 2015, International journal of cancer.

[22]  P. Newcomb,et al.  A Randomized Trial to Increase Colonoscopy Screening in Members of High-Risk Families in the Colorectal Cancer Family Registry and Cancer Genetics Network , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[23]  J. Hopper,et al.  Cost-effectiveness of family history-based colorectal cancer screening in Australia , 2014, BMC Cancer.

[24]  H. Brenner,et al.  Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. , 2013, European journal of cancer.

[25]  R. Sanson-Fisher,et al.  Individual- and provider-level factors associated with colorectal cancer screening in accordance with guideline recommendation: a community-level perspective across varying levels of risk , 2013, BMC Public Health.

[26]  Abdallah Namoune,et al.  Predicting user attention in complex web pages , 2012, Behav. Inf. Technol..

[27]  Jan H. Spyridakis,et al.  The effect of visual design and placement of intra-article navigation schemes on reading comprehension and website user perceptions , 2012, Comput. Hum. Behav..

[28]  R. Sanson-Fisher,et al.  Colorectal cancer risk assessment and screening recommendation: a community survey of healthcare providers' practice from a patient perspective , 2012, BMC Family Practice.

[29]  S. Allen,et al.  From the Australian Commission on Safety and Quality in Health Care , 2011, The Medical journal of Australia.

[30]  T. Levin,et al.  Organized colorectal cancer screening in integrated health care systems. , 2011, Epidemiologic reviews.

[31]  Benjamin F. Crabtree,et al.  Colorectal Cancer Screening Among Primary Care Patients: Does Risk Affect Screening Behavior? , 2011, Journal of Community Health.

[32]  K. Barlow-Stewart,et al.  ‘Start the Conversation’: The New South Wales (Australia) Family Health History Campaign , 2009, Public Health Genomics.

[33]  J. Young,et al.  Family history? The forgotten question in high‐risk colorectal cancer patients , 2009, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[34]  A. Zaslavsky,et al.  Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. , 2009, Archives of internal medicine.

[35]  Mack T Ruffin,et al.  Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices: A Report From the Prompting and Reminding at Encounters for Prevention Project , 2008, Medical care.

[36]  R. Wender,et al.  How to Increase Colorectal Cancer Screening Rates in Practice , 2007, CA: a cancer journal for clinicians.

[37]  D. Ransohoff,et al.  Data Sources for Measuring Colorectal Endoscopy Use Among Medicare Enrollees , 2007, Cancer Epidemiology Biomarkers & Prevention.

[38]  P Glasziou,et al.  Screening for colorectal cancer using the faecal occult blood test, Hemoccult. , 2007, The Cochrane database of systematic reviews.

[39]  Nancy Breen,et al.  Primary Care Provider Attitudes are Associated With Smoking Cessation Counseling and Referral , 2005, Medical care.

[40]  P. Chondros,et al.  Observed intra-cluster correlation coefficients in a cluster survey sample of patient encounters in general practice in Australia , 2004, BMC medical research methodology.

[41]  J. McLaughlin,et al.  A comparison of self-reported colorectal cancer screening with medical records. , 2003, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[42]  P. McElduff,et al.  Screening for bowel cancer among NSW adults with varying levels of risk: a community survey , 2002, Australian and New Zealand journal of public health.

[43]  S. S. Young,et al.  Resampling-Based Multiple Testing: Examples and Methods for p-Value Adjustment , 1993 .

[44]  Cornish Jk.  The 1986 Australian census of population and housing. , 1983 .