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Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment.

ABSTRACT: BACKGROUND:The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of spending on effective interventions to increase adherence has not yet been quantified. OBJECTIVES:To estimate (i) reductions in CRC cases and deaths for 2020-2040 attributable to, and (ii) the threshold for cost-effective investment (TCEI) in, effective future interventions to improve participation in the NBCSP. METHODS:A comprehensive microsimulation model, Policy1-Bowel, was used to simulate CRC natural history and screening in Australia, considering currently reported NBCSP adherence rates, i.e. iFOBT participation (?40%) and diagnostic colonoscopy assessment rates (?70%). Australian residents aged 40-74 were modelled. We evaluated three scenarios: (1) diagnostic colonoscopy assessment increasing to 90%; (2) iFOBT screening participation increasing to 60% by 2020, 70% by 2030 with diagnostic assessment rates of 90%; and (3) iFOBT screening increasing to 90% by 2020 with diagnostic assessment rates of 90%. In each scenario, we estimated CRC incidence and mortality, colonoscopies, costs, and TCEI given indicative willingness-to-pay thresholds of AUD$10,000-$30,000/LYS. RESULTS:By 2040, age-standardised CRC incidence and mortality rates could be reduced from 46.2 and 13.5 per 100,000 persons, respectively, if current participation rates continued, to (1) 44.0 and 12.7, (2) 36.8 and 8.8, and (3) 31.9 and 6.5. In Scenario 2, 23,000 lives would be saved from 2020-2040 vs current participation rates. The estimated scenario-specific TCEI (Australian dollars or AUD$/year) to invest in interventions to increase participation, given a conservative willingness-to-pay threshold of AUD$10,000/LYS, was (1) AUD$14.9M, (2) AUD$72.0M, and (3) AUD$76.5M. CONCLUSION:Significant investment in evidence-based interventions could be used to improve NBCSP adherence and help realise the program's potential. Such interventions might include mass media campaigns to increase program participation, educational or awareness interventions for practitioners, and/or interventions resulting in improvements in referral pathways. Any set of interventions which achieves at least 70% iFOBT screening participation and a 90% diagnostic assessment rate while costing under AUD$72 million annually would be highly cost-effective (

SUBMITTER: Worthington J

PROVIDER: S-EPMC6996821 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment.

Worthington Joachim J Lew Jie-Bin JB Feletto Eleonora E Holden Carol A CA Worthley Daniel L DL Miller Caroline C Canfell Karen K

PloS one 20200203 2

<h4>Background</h4>The Australian National Bowel Cancer Screening Program (NBCSP) provides biennial immunochemical faecal occult blood test (iFOBT) screening for people aged 50-74 years. Previous work has quantified the number of colorectal cancer (CRC) deaths prevented by the NBCSP and has shown that it is cost-effective. With a 40% screening participation rate, the NBCSP is currently underutilised and could be improved by increasing program participation, but the maximum appropriate level of s ...[more]

PMID: 32012174

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Project description:OBJECTIVES AND DESIGN:This field experiment aimed to compare bowel cancer screening participation rates prior to, during and after a mass media campaign promoting screening, and the extent to which a higher intensity campaign in one state led to higher screening rates compared with another state that received lower intensity campaign exposure. INTERVENTION:An 8-week television-led mass media campaign was launched in selected regions of Australia in mid-2014 to promote Australia's National Bowel Cancer Screening Program (NBCSP) that posts out immunochemical faecal occult blood test (iFOBT) kits to the homes of age-eligible people. The campaign used paid 30-second television advertising in the entire state of Queensland but not at all in Western Australia. Other supportive campaign elements had national exposure, including print, 4-minute television advertorials, digital and online advertising. OUTCOME MEASURES:Monthly kit return and invite data from NBCSP (January 2012 to December 2014). Return rates were determined as completed kits returned for analysis out of the number of people invited to do the iFOBT test in the current and past 3 months in each state. RESULTS:Analyses adjusted for seasonality and the influence of other national campaigns. The number of kits returned for analysis increased in Queensland (adjusted rate ratio 20%, 95% CI 1.06% to 1.35%, p<0.01) during the months of the campaign and up to 2 months after broadcast, but only showed a tendency to increase in Western Australia (adjusted rate ratio 11%, 95% CI 0.99% to 1.24%, p=0.087). CONCLUSIONS:The higher intensity 8-week television-led campaign in Queensland increased the rate of kits returned for analysis in Queensland, whereas there were marginal effects for the low intensity campaign elements in Western Australia. The low levels of participation in Australia's NBCSP could be increased by national mass media campaigns, especially those led by higher intensity paid television advertising.

Project description:BackgroundIn Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists' experiences of HMR time investment.ObjectiveThis study aimed to explore accredited pharmacists' experiences of HMR practice regarding time investment in the study's defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient's General Practitioner, including any liaison time).MethodsAn electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.ResultsThere was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).ConclusionsAccredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.

Project description:ObjectivesThis field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years.DesignAdjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation.SettingAustralia.ParticipantsAll Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019.InterventionsA multiwave national integrated media campaign to promote participation in the NBCSP.Main outcome measuresiFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants).ResultsThe rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign.ConclusionsThe campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.

Project description:Interventions: The ‘general practice-led intervention’ is a multi-component intervention identified in a synthesised evidence review of interventions effective at increasing Colorectal Cancer (CRC) screening participation and co-designed with general practice staff. The co-design was completed in March 2023 with 38 General Practice Staff and from across Australia. Co-design participants discussed implementation barriers and enablers of intervention components with evidence-based effectiveness at increasing CRC screening. The co-design results were analyzed against implementation science frameworks and the barriers assessed against implementation barriers identified in the evidence review. The final intervention to be delivered to general practice healthcare providers will comprise of a combination of the following components: 1.Decision-aid tools adapted from existing source (CRISP tool) Anticipated completion time of 5 minutes per patient. 2.Reminder prompts activated within existing general practice software Medical Director 3. Integration of the National Cancer Screening Register (NCSR) within practice software systems and use of a Cancer Screening Toolkit and clinical audits of patient data using an existing resource developed by the Cancer Institute NSW (Primary Care Cancer Control Quality Improvement Toolkit). Anticipated time by practice staff 1 hr per fortnight for 6-month duration. 4.Learning modules and digital resources to educate on guideline-appropriate screening pathways for GPs: - 2 x 1 hour online self-paced modules developed by GPEx with the learning outcomes: - Be aware why General Practice needs to endorse participation in the National Bowel Cancer Screening Program and be able to explain to patients the risks in not Primary outcome(s): Co-primary Implementation Effectiveness Outcome The co-primary implementation effectiveness outcome is guideline-appropriate CRC screening recommendations provided. The co-primary implementation effectiveness outcome will be assessed using a study specific data collection tool integrated into Clinical Information Systems used in General Practice to undertake audits of medical records. [ Co-primary Implementation Effectiveness Outcome will be measured mid-trial at 6-months duration since trial commencement and at post-trial, 12-months duration since trial commencement. ];Co-primary Clinical Effectiveness Outcome The co-primary clinical effectiveness outcome is guideline-appropriate CRC screening tests completed by practice patients (inc. NBCSP kits, GP-initiated kits & colonoscopies). The co-primary clinical effectiveness outcome will be assessed using Health Analytics software used in General Practice to undertake audits of medical records. [ Co-primary Clinical Effectiveness Outcome will be measured pre-trial and post-trial after 12 months since trial commencement. ] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

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Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment.

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Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment.

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