The Colorectal cancer RISk Prediction (CRISP) trial: a randomised controlled trial of a decision support tool for risk-stratified colorectal cancer screening

Emery, Jon; Jenkins, Mark A.; Saya, Sibel; Chondros, Patty; Oberoi, Jasmeen; Milton, Shakira; Novy, Kitty; Habgood, Emily; Karnchanachari, Napin; Pirotta, Marie; Trevena, Lyndal; Bickerstaffe, Adrian; Lourenço, Richard De Abreu; Anna, Crothers; Ouakrim, Driss Ait; Flander, Louisa; Dowty, James G.; Walter, Fiona M.; Clark, Malcolm; Doncovio, Sally; Etemadmoghadam, Dariush; Fishman, George; Macrae, Finlay; Winship, Ingrid; McIntosh, Jennifer

doi:10.3399/bjgp.2022.0480

Cited by 7 publications

(7 citation statements)

References 36 publications

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“…Our main results are in line with Emery et al [15] in which personalized screening increased risk appropriate screening by 21%. Their intervention was delivered in person and followed by a consultation with a general practitioner who could order a fecal blood test or book a colonoscopy appointment.…”

Section: Discussionsupporting

confidence: 93%

“…Most studies have tested its influence on overall screening uptake, with multiple studies and a meta-analysis concluding that personalized risk is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) information results in little to no effect [10][11][12][13][14]. Only two studies focused on appropriate screening, meaning use of colonoscopy by those at high risk and noninvasive tests by those at low risk [15,16]. It appears that communicating risk alone without personalized screening recommendations is insufficient to influence individuals' decision about screening test [16].…”

Section: Introductionmentioning

confidence: 99%

“…It appears that communicating risk alone without personalized screening recommendations is insufficient to influence individuals' decision about screening test [16]. Emery et al [15] showed an increase of 21% in risk-appropriate screening after communicating risk-based recommendations. However, risk and screening recommendations were communicated to participants by health providers in primary care, which is a challenging strategy in an organized screening setting.…”

Section: Introductionmentioning

confidence: 99%

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Colorectal cancer screening based on predicted risk: a pilot randomized controlled trial

Plys,

Bulliard,

Chaouch

et al. 2024

Preprint

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Background & Aims: Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk (i.e. personalized screening) may maximize benefit with lower risks, individual burdens, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on appropriate screening uptake in an organized screening setting. Methods: Pilot randomized controlled trial among residents aged 50-69 years old not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and corresponding screening recommendation. The control group received a brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, colonoscopy if ≥6%), assessed by a mailed questionnaire at 6 months. A secondary outcome was overall screening uptake. Results: Of 5396 invitations, 1059 people responded (19%), of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% (SD 0.5), age 52.2 years (SD 2.2), 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95%CI 6%-22%, p<0.001). Overall screening uptake was 50% in the intervention and 49% in the control group (absolute difference 1%, 95CI -7%-10%, p=0.758). Conclusions: In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk. Trial registration: Clinicaltrials.govNCT05357508.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Colorectal cancer screening based on predicted risk: a pilot randomized controlled trial

Plys,

Bulliard,

Chaouch

et al. 2024

Preprint

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“…25 In addition, the percentage of eligible individuals who completed a FIT were likely to be underestimated, as only 80% of people aged 50–60 years old attend general practice every year, 26 and not everyone nominates a GP to receive their NBCSP results. In the authors’ recent trial, 27 29.7% (131/441) of people did not have their NBSCP kit results in their patient record when compared with their NBCSP records; this was similar in both arms of the same trial (28.4% in the control arm, 30.8% in the intervention arm) (unpublished data). As such, the authors expect that the underestimation would be similar for both intervention and control practices, and the estimated absolute intervention effect would be unbiased.…”

Section: Discussionmentioning

confidence: 91%

Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.

McIntosh,

Jenkins,

Wood

et al. 2023

Br J Gen Pract

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Background: Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice screening program, but uptake is low (43.5%). Increasing participation will reduce morbidity and mortality associated with CRC. Endorsement by general practitioners is strongly associated with increasing screening uptake. Aim: SMARTscreen aimed to test the efficacy of sending a multi-intervention SMS from general practice to 50-60-year-old patients due to receive the NBCSP kit on NBCSP uptake compared to “usual care”. Design and Setting: A stratified cluster randomised controlled trial involving 21 Australian general practices in Western Victoria, Australia. Methods: For intervention practices, patients due to receive the NBCSP kit within the 6-month intervention period were sent an SMS just prior to receiving their NBCSP kit. The SMS included a personalised message from the patient’s general practice endorsing the NBCSP kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care (opportunistic screening). The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12-months from randomisation, estimated using generalised linear model regression. Results: Thirty-nine percent (1143/2537) of patients in 11 intervention practices and 23% (583/2914) of patients in 10 control practices had a FIT result in the electronic health records, a 16.5% increase (95% confidence internal:2.02-30.9%). Conclusion: The SMS increased NBCSP kit return in 50-to-60-year-old general practice patients. This finding informed a larger trial –SMARTERscreen– to test this intervention in a broader Australian population.

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“…We randomised individuals as the risk of contamination was expected to be low based on similar trials [28] and the intervention was delivered at an individual level. Further, we would have required a larger sample size if the unit of randomisation was the practice.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Should I Take Aspirin? (SITA): randomised controlled trial of a decision aid for cancer chemoprevention

Onwuka,

McIntosh,

Macrae

et al. 2024

Br J Gen Pract

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Background Australian guidelines recommend that all people aged 50-70 years old consider taking low-dose aspirin to reduce the risk of colorectal cancer (CRC). Aim To determine the effect of a consultation with a researcher in general practice using a decision aid about taking low-dose aspirin to prevent CRC on informed decision-making and low-dose aspirin uptake compared to a general CRC prevention brochure. Design and Setting Individually randomised controlled trial in six general practices in Victoria, Australia, from October 2020 to March 2021. Method Patients aged 50-70 years attending a general practitioner (GP) were recruited consecutively. The intervention was a consultation using a decision aid to discuss taking aspirin to reduce CRC risk; control consultations discussed reducing CRC risk generally. The self-reported co-primary outcomes were informed choices about taking aspirin at one month and low-dose aspirin uptake at six months. Results 261 participants (86% of eligible patients) were randomised into trial arms (129 intervention, 132 control). 17.7% (20/113) of intervention and 7.6% (9/118) control participants reported making an informed choice at one month, an estimated 9.1% (95% CI 0.29% to 18.5) between-arm difference in proportions [odds ratio (OR) 2.47 (97.5% CI:0.94 to 6.52) p=0.074]. The proportions of individuals who reported using aspirin at six months were: 10.2% (12/118) intervention vs 13.8% (16/116) control (estimated between-arm difference: -4.0% (95% CI: -13.5 to 5.5); [OR= 0.68 (97.5% CI:0.27 to 1.70), p= 0.692]. Conclusion The decision aid improved informed decision-making; but has little effect on long-term regular use of aspirin to reduce CRC risk.

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The Colorectal cancer RISk Prediction (CRISP) trial: a randomised controlled trial of a decision support tool for risk-stratified colorectal cancer screening

Cited by 7 publications

References 36 publications

Colorectal cancer screening based on predicted risk: a pilot randomized controlled trial

Colorectal cancer screening based on predicted risk: a pilot randomized controlled trial

Increasing bowel cancer screening using SMS in general practice: the SMARTscreen trial.

Should I Take Aspirin? (SITA): randomised controlled trial of a decision aid for cancer chemoprevention

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