Australia and New Zealand have the highest rates of colorectal cancer (CRC) worldwide. Despite this, in Australia, many people at increased risk are not having colonoscopies when indicated while many at average risk are being over-screened with colonoscopies, despite recommendations of non-invasive faecal occult blood testing (FOBT).
To increase risk-appropriate screening for CRC by developing and implementing a risk prediction tool for use in primary care in Australia.
Following the MRC framework for developing and implementing complex interventions in primary care (UK), we have conducted a four-year program of research to design and implement a colorectal cancer risk prediction tool (CRISP). Clinicians, IT experts, policy makers, epidemiologists, primary care researchers and geneticists informed the CRISP prototype. Qualitative studies using simulated consultations with clinicians were conducted to optimise the usability of CRISP and a study with primary care patients was conducted to maximise the coherence of the risk outputs. A Phase II trial was conducted to measure the feasibility of using CRISP with a practice nurse and an efficacy study based on the methods of the Phase II study is currently underway. A case study of a clinic using CRISP as a practice nurse led tool with patients eligible for CRC screening is underway to explore implementation methods. The study outcomes include the development and implementation of an effective CRC risk prediction tool using measurements of risk-appropriate screening.
CRISP has been developed as a web-based risk prediction tool using an Australian risk model. CRISP has been demonstrated as a useable, feasible tool using world-leading risk communication.
Cancer risk tools are a feasible option for increasing risk-appropriate screening for colorectal cancer.