Rapid Fire Best of the Best Poster Oral Clinical Oncology Society of Australia Annual Scientific Meeting 2021

The CRISP Trial: a randomised controlled trial of a risk assessment and decision support tool for risk-stratified colorectal cancer screening in primary care. (#270)

Jon Emery 1 , Mark Jenkins 2 , Sibel Saya 1 , Patty Chondros 3 , Shakira Milton 1 , Lyndal Trevena 4 , Adrian Bickerstaffe 2 , Richard De Abreu Lourenco 5 , Finlay Macrae 6 , Ingrid Winship 7 , Jennifer McIntosh 8
  1. Department of General Practice and Centre for Cancer Research, University of Melbourne, Carlton, VIC, Australia
  2. 2. Centre for Epidemiology and Biostatistics, School of Population and Global Health,, University of Melbourne, Melbourne, VIC, Australia
  3. Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
  4. School of Public Health, The University of Sydney, Sydney, NSW, Australia
  5. Centre for Health Economic Research and Evaluation, University Technology Sydney, Sydney, NSW, Australia
  6. Colorectal Medicine and Genetics, Royal Melbourne Hospital, Melbourne, VIC, Australia
  7. Genomic Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
  8. HumaniSE Lab, Department of Software Systems and Cybersecurity, Monash University, Melbourne, VIC, Australia

Background

A risk-stratified approach to colorectal cancer (CRC) screening could result in a more acceptable balance of benefits and harms, and may be more cost-effective.  The CRISP Trial tested the effect of a consultation in Australian general practice using a computerised risk assessment and decision support tool on the incidence of risk-appropriate CRC screening.

Methods

Eligible participants were aged 50-74 attending their general practitioner (GP). Intervention consultations included assessment of CRC risk using the CRISP risk assessment and decision support tool, discussion of risk-appropriate CRC screening recommendations, and a report to the participant and their GP. Control group consultations focused on modifiable lifestyle risk factors and a brochure on cancer prevention. Parallel, individual randomisation, 1:1 stratified by practice, occurred via an on-line platform. Participants and researchers conducting data extraction and statistical analyses were blinded to group allocation.  The primary outcome was risk-appropriate CRC screening at 12-months.  

Results

We randomised 734 participants (369 intervention, 365 control; accrual target met); the primary outcome was determined for 722 (362 intervention, 360 control).  There was a 6.5% increase (95% CI: -0.28 to 13.2%) in risk-appropriate screening in the intervention arm compared to control arm [71.6% vs 65%; OR: 1.36 (95% CI: 0.99 to 1.86) p = 0.06]. The effect was greater in those due CRC screening during the follow-up period [59.8% vs 38.9%; difference 20.3% (95% CI:10.3 to 30.4%); OR: 2.31 (95% CI 1.51 to 3.53) p < 0.001] and occurred principally by increasing faecal occult blood testing in those at average risk.

Conclusion

A consultation in general practice using a risk assessment and decision support tool can increase risk-appropriate CRC screening. The CRISP intervention could commence in people in their fifth decade to ensure people start CRC screening at the optimal age with the most cost-effective test.

  1. Walker JG, Macrae F, Winship I, Oberoi J, Saya S, Milton S, Bickerstaffe A, Dowty JG, De Abreu Lourenço R, Clark M, Galloway L, Fishman G, Walter FM, Flander L, Chondros P, Ait Ouakrim D, Pirotta M, Trevena L, Jenkins MA, Emery JD. (2018) The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial. Trials, 19(1):397. doi: 10.1186/s13063-018-2764-7