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Colorectal Cancer Screening in Primary Care

ABSTRACT: The implementation of screening programs for colorectal cancer by screening for fecal occult blood has proven effective in reducing the incidence and mortality from this type of neoplasms. However, to ensure the efficiency of the programs require population participation rates of at least 50%. Experiences in our country show that the population participation is far from this recommended minimum number. Interventions to promote preventive activities in primary care are well received by the population; in the case of colorectal cancer, direct recommendation of primary care professionals to carry out the screening is one of the factors with greatest impact on increasing population participation in such programs. Care overload, circuit design for screening without the direct intervention of primary care professionals and the multiplicity of tasks that they must face, are elements that influence the low recommendation for screening in the target population who consults for any other reason. The introduction of specific reminders in electronic medical record (in widespread use in primary care), as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase of at least 10% in participation of the target population, increasing the efficiency of screening programs. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals.

DISEASE(S): Colorectal Neoplasms

PROVIDER: 2146597 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Intervention Arm A (low intensity support) - Primary health care centres in this arm are offered a low intensity model of support to prepare them to offer the National Bowel Cancer Screening Program bowel screening kit to their eligible clients (aged 50-74). This support includes access to an online training module for health centre staff about bowel cancer and bowel cancer screening and other resources to assist them to deliver the program to their clients. When eligible clients attend the health centre they will be invited to screen and receive a bowel screening kit as part of the Alternative Pathway. The on-line training module includes the following topics: About bowel cancer and bowel cancer screening; Risk factors for bowel cancer; Bowel cancer treatment; Incidence, survival and screening participation rates; About the National Bowel Cancer Screening Program; About the Alternative Pathway; Talking about bowel screening with your Indigenous clients (clinical and social aspects); Assessing suitability for screening; Understanding test results; General Practitioner assessment; Colonoscopy; Risks and benefits of screening. The online training module will take health professionals about one hour to complete. It was designed specifically for the pilot to relate directly to the context of primary health care centres and health professionals providing services to Indigenous clients in the eligible age group. It includes the use of animations, a music video, and with voiceovers by Aboriginal and Torres Strait Islander actors (two male, one female). Short quizzes (three to six questions each) test participant knowledge and learning throughout the module. Designed primarily for Indigenous Health Workers, the resources can be used by other health professionals. Other resources developed specifically for this project and provided as part of the low intensity support model include: - A manual for implementation: ‘The Alternative Pathway in your Health Centre’ Primary outcome(s): Outcome: Screening participation by client population The primary outcome is the screening participation rate in the National Bowel Cancer Screening Program by Indigenous people aged 50 to 74, who are clients of participating primary health care centres that have received low intensity (Arm A) or intensive support (Arm B) in offering screening to their clients. The client population screening participation rate is calculated as the total number of eligible (aged 50 to 74) Indigenous clients of a participating primary health care centre, who return for testing a National Bowel Cancer Screening Program kit received from the health centre during the 12 months following commencement of the trial; as a proportion of the total number of active eligible (aged 50 to 74) Indigenous clients of that health centre. (An active client is defined by the Royal Australian College of General Practitioners and the National Aboriginal Community Controlled Health Organisations as: A patient who has attended the practice/service three or more times in the past 2 years.) Number of clients who returned kits for testing and total active eligible Indigenous clients for each health centre will be aggregated to compare the population screening participation rates of eligible (aged 50 to 74) Indigenous clients of health centres that are: - in Arm A and Arm B; - in different categories of remoteness (urban, regional, remote); - in different jurisdictions (states/territories); - in different Hot Zone restriction categories (Number of months by which an area is restricted by the National Bowel Cancer Screening Program from distributing kits during months in which the average monthly temperature is higher than 30 degrees Celsius.) The outcome will also be compared with the screening participation rate of Indigenous Australians through the usual pathway of the National Bowel Cancer Screening Program, as reported by the Australian Institute of Health and Welfare in the Program’s annual monitoring report, at baseline (within two months prior to commencement of the trial) and at 12 and 18 months following commencement of the trial. [Timepoint (1): - Screening participation measured after 12 months following commencement of trial; and at 18 months after commencement of trial. (The National Bowel Cancer Screening Program allows six months after the distribution of kits for screening participants to return the completed kits for testing.) - Active Client population measured at commencement of trial and at 12 months following commencement of trial. (Number of active clients and other health centre characteristics will be reported by participating health centres at baseline through an online Health Centre Profile form, completed as part of the application process to take part in the trial, and updated at six and twelve months following commencement of the trial) ] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Open (masking not used);Assignment: Parallel;Type of endpoint: Efficacy

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Colorectal Cancer Screening in Primary Care

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