The CRISP trial: a risk assessment tool to inform bowel cancer screening in general practice patients

INTERVENTION: The intervention is a web based Colorectal cancer RISk Prediction tool (CRISP) risk assessment tool utilising a risk model to provide patients with a personalised risk assessment and colorectal cancer screening advice based on their risk. Patients in the intervention group will be invited to complete the risk tool with a trained researcher prior to a consultation with their GP. The tool will take a maximum of 7 minutes and will be completed at baseline only. Participants will receive their risk of colorectal cancer and screening advice based on their risk which they will take with them into their consultation with their GP. All participants will also complete a survey collecting information about cancer risk perception, worry and bowel cancer screening intention and behaviour at baseline, 1 month, 6 months and 12 months after recruitment. The follow up survey should take no more than 15 minutes to complete and will be sent through the post or a link to the online survey will be sent via email. We will ask for permission to access GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP) 1, 3 and 5 years after the participants enrol to track the colorectal cancer screening they have had. CONDITION: Colorectal Cancer PRIMARY OUTCOME: The primary outcome will be the proportion of participants who have had risk‐appropriate screening after 12 months' follow‐up. Appropriateness of screening will be determined by their absolute 5‐year risk of CRC, using a 1% threshold and completion of FOBT, colonoscopy no screening, or a referral to a Familial Cancer Centre for genetic counselling if indicated by their family history. Patient self‐report at 12 months will tell us what screening each patient has had and this will be cross‐checked with GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP) SECONDARY OUTCOME: Cancer worry using the Cancer Worry Scale Clinical outcomes of screening tests, obtained from GP records including detection of pre‐malignancies and colorectal cancer lesions Health service utilisation and health care costs. We will measure GP consultations, referrals for colonoscopy, and completion of FOBT. Costs of delivering the CRISP and control consultations will be calculated. INCLUSION CRITERIA: Primary care patients between 50 and 74 years old who have an appointment with their general practitioner (GP). This applies only to patients of consenting GPs who have been recruited into the trial. ; This includes assessment of GP consultations, colonoscopy services, FOBT and associated pathology services. Costs of delivering the CRISP and control consultations will also be calculated. Any other associated changes in health care utilisation will be captured through access to patients Medicare data. Intentions to have FOBT and/or colonoscopy in the next three months based on items from the Theory of Planned Behaviour Proportion of participants who have had risk‐appropriate screening after 3 years' follow‐up, measured as above for primary endpoint. We will ask for permission to access GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP) to determine screening undertaken at 3 years. Proportion of participants who have had risk‐appropriate screening after 5 years' follow‐up, measured as above for primary endpoint. We will ask for permission to access GP records, records from Medicare, Victorian Admissions and Emergency Dataset (VAED) and from the National Bowel Screening Program (NBCSP) to determine screening undertaken at 5 years. Risk perception: personal perceived risk, absolute and comparative, will be measured using an existing validated tool ‐ the 'Family History Questionnaire'.