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Pilot of a general practice-led intervention to optimise National Bowel Cancer Screening Program (NBCSP) participation.

ABSTRACT: 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

DISEASE(S): Cancer-bowel-back Passage (rectum) Or Large Bowel (colon),Colorectal Cancer Screening

PROVIDER: 23447 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: The intervention is a SMS personalised message from the general practice sent to the patient’s smartphone with links to: 1. A message from the general practitioners (GPs) at the general practice (e.g. Hello. xxx This is a health message from the GPs at xxx Medical Practice. Your free bowel cancer screening kit will arrive in the post soon. We strongly encourage you to do this test. If cancer is detected early over 90% of bowel cancers are successfully treated. We recommend that you watch the videos below.) 2. A video of a person talking about their positive experience of doing the National Bowel Cancer Screening Program (NBCSP) Immunochemical Faecal Occult Blood Test (IFOBT) test 3. A animated video demonstrating how to complete the test 4. Links to information from Cancer Council Australia The SMS is sent from the general practice one month prior to patients 50th, 52nd, 54th, 56th, 58th and 60th birthdays. The intervention period is six months long, there will be 6 rounds of SMS sent during that time to any active patient due to receive their NBCSP kit. Patients will only receive one SMS. The number of patients due to be sent the SMS will be recorded in PEN CAT4 clinical audit software and the number of SMS sent is recorded on the GoShare Plus platform. Data, the number of patients due to receive the SMS and the number of SMS sent is recorded at the general practice. This data is collected by the project manager. Primary outcome(s): The primary outcome will be the proportion of patients who complete the NBCSP after six months from the total number of eligible patients who are about to have their 50th, 52nd, 54th, 56th, 58th, or 60th birthdays. This outcome will be measured by the number of FOBT results sent to the general practice for patients in this age group. Aggregate data (number of FOBTs returned in each age group) will be collected from the electronic medical records. [From commencement of the 6 month intervention period to 6 months after completion of the intervention period. ] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

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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Pilot of a general practice-led intervention to optimise National Bowel Cancer Screening Program (NBCSP) participation.

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