Dataset Information

A trial to increase participation in the National Bowel Cancer Screening Program by eligible Indigenous clients of participating primary health care centres that receive either an intensive model of support or a low intensity model of support in offering screening.

ABSTRACT: 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

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

PROVIDER: 2467948 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: We are assessing the impact of the National Bowel Cancer Screening Program (NBCSP) by comparing participation rates of people with and without Severe Mental Illness (SMI) and looking at health outcomes. We will be using data collected from Aug 2006 - latest available. We are linking data using Commonwealth data (NBCSP, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Australian Cancer Database & the National Death Index) to compare bowel cancer screening participation in people with SMI to those from the general population. We will additionally link these to the NSW cancer registry and hospital data to examine care pathways from diagnosis through treatment and end-of-life care. We will also conduct a consultation with people with experience of SMI and Colorectal cancer and people with SMI in peer support roles who can provide their perspective on the barriers faced by people with SMI to gaining timely screening, diagnosis and optimal care. These participants will be recruited from New South Wales consumer organisations and organisations with a strong focus on provision of peer support and advocacy. We will use a semi structured group interview schedule to facilitate discussion of a single focus group of 15 people. The group will consist of both people with lived experience who have direct experience of bowel cancer (n=10), as well as other people with lived experience who have supported people in this situation – as peer support workers or in other consumer advocacy/support roles (n=5). We will use this qualitative arm of the study to further develop our understanding of the quantitative findings. The consultation will also develop ideas on how to improve access to care. Primary outcome(s): Participation rates in the National Bowel Cancer Screening Program assessed using data from the NBCSP.[Person-years will be calculated from entry into the study (2006) (the date of commencement of the NBCSP) or from the year that people become eligible for screening (i.e. age 50), whichever occurs later.. This is a retrospective cohort study, so all of the outcomes have already occurred and were recorded in the administrative data. This will be assessed when we receive the data.];Colonoscopy rates assessed using data from the NBCSP [Person-years will be calculated from entry into the study (2006 the date of commencement of the NBCSP), or from the year that people become eligible for screening (i.e. age 50), whichever occurs later, until colonoscopy. This is a retrospective cohort study, so all of the outcomes have already occurred and have been recorded in the administrative data.];Cancer diagnosis using data from the Australian Cancer Database[Person-years will be calculated from entry into the study (2006 the date of commencement of the NBCSP), or from the year that people become eligible for screening (i.e. age 50), whichever occurs later, until cancer diagnosis. This is a retrospective cohort study, so all of the outcomes have already occurred and have been recorded in the administrative data.] Study Design: Purpose: Screening;Duration: Longitudinal;Selection: Case control;Timing: Both

Project description: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

Project description:Interventions: 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. Primary outcome(s): 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)[12 months post recruitment] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Open (masking not used);Assignment: Parallel;Type of endpoint: Efficacy

Project description:Interventions: The intervention is a novel, shared model of care between cancer services and primary health care using an interactive e-care plan called Inca and telehealth using telemedicine technology. It is being implemented at 2 public and 2 private cancer services in the South Eastern Sydney Local Health District. The e-care plan program is integrated with GP clinical information systems and includes care plan templates for colorectal and breast cancer follow-up care developed from the published literature and agreed guidelines for survivorship care plans. The e-care plan program provides a collaborative space for clinicians and patients to agree on the goals, tasks, responsibilities and the scheduling and monitoring of care. Other functionalities include the sharing of pathology results, measures (e.g. BMI, blood pressure), a health summary and a progress notes section for the specialist, GP or patient to add a note. Documents can be uploaded and downloaded. It provides the basis for non-urgent communication between specialists, GPs, patients and other care team members (e.g. allied health providers) who can be added to the care team and given access. Inca automatically emails notifications to the care team when changes are made to the e-care plan or when upcoming tasks and appointments are due. Patients will be emailed reminders for appointments or tasks that are upcoming from Inca. The e-care plan is not integrated with cancer service clinical systems. Cancer services and patients access the e-care plan through an online portal. This is a non-randomised quasi-experimental trial. Patients at the St George Cancer Centre and the Prince of Wales Private will be allocated to the intervention. Patients at the Prince of Wales Nelune Comprehensive Cancer Centre and the S Primary outcome(s): The quality of communication and information shared to support patient follow-up will be assessed by comparing participant satisfaction and experiences with communication and information sharing within and between groups. Methods Questionnaires will be administered at baseline, 9 months plus 18 months post commencement of follow-up care for delayed intervention group: The Short Form Patient Satisfaction Questionnaire (access, interpersonal manner and communication subscales) (Marshall GN, 1994) and The Survivors Unmet Needs Survey (access and continuity of care subscale) (Campbell HS, 2011) GP Questionnaire - Satisfaction with communication (Jefford M, 2008). Specialist and care coordinator questionnaire (satisfaction with communication and information shared) Qualitative interviews with a sample of intervention participants (10 patients, 5-7 GPs and 3-5 specialists) by phone with a researcher at 9 months and 18 months post commencement of follow-up care for the delayed intervention group [9 months post commencement of follow-up care plus 18 months for the delayed intervention group];Access to and continuity of follow-up care will be assessed by comparing participant satisfaction and experiences with follow-up care within and between groups. Methods: Questionnaires will be administered at baseline, 9 months plus 18 months post commencement of follow-up care for delayed intervention group: Short Form Patient Satisfaction Questionnaire (Marshall GN, 1994) and The Survivors Unmet Needs Survey (access and continuity of care subscale) (Campbell HS, 2011) Qualitative interviews with a sample of intervention participants (10 patients, 5-7 GPs and 3-5 specialists) by phone with a researcher at 9 months and 18 months post commencement of follow-up care for the delayed intervention group [9 months post commencement of follow-up care plus 18 months for the delayed intervention group] Study Design: Purpose: Prevention; Allocation: Non-randomised trial

Dataset Information

A trial to increase participation in the National Bowel Cancer Screening Program by eligible Indigenous clients of participating primary health care centres that receive either an intensive model of support or a low intensity model of support in offering screening.

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