What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

Flander, Louisa; Dekker, Evelien; Andersen, Berit; Larsen, Mette Bach; Steele, Robert; Malila, Nea; Sarkeala, Tytti; Vlugt, Manon van der; Klerk, Clasine de; Knottnerus, Bart; Bertels, Lucinda; Woudstra, Anke J.; Spaander, Manon C.W.; Fransen, Mirjam P.; Heinävaara, Sirpa; Dillon, Marcus L.; Ouakrim, Driss Ait; Jenkins, Mark A.

doi:10.1177/10732748221121383

Cited by 5 publications

(5 citation statements)

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“…Another limitation of the study was the relatively low response rate to recall (~25% overall). This is only slightly less than the 33% response rate achieved with the Australian National Bowel Cancer Screening Program, highlighting the potential difficulties in engaging patients in preventative screening for asymptomatic disease even when programs are evidence-based and well resourced 34 . The COVID-19 pandemic may have also contributed to the low response rate, with the project being interrupted for 8 months.…”

Section: Discussionmentioning

confidence: 90%

“…This is only slightly less than the 33% response rate achieved with the Australian National Bowel Cancer Screening Program, highlighting the potential difficulties in engaging patients in preventative screening for asymptomatic disease even when programs are evidence-based and well resourced. [34] The COVID-19 pandemic may have also contributed to the low response rate, with the project being interrupted for 8 months. The rates of successful recall also differed significantly between practices (range 10%-40%), with higher-performing practices often having additional staff to assist with recall.…”

Section: Discussionmentioning

confidence: 99%

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Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Prince,

Hoque,

Kim

et al. 2024

Hepatology Communications

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Background: Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression. Methods: A cloud-based software solution (“the Liver Toolkit”) was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded. Results: Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0–9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction–associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46, p=0.041). Conclusions: This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Prince,

Hoque,

Kim

et al. 2024

Hepatology Communications

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“…Our findings are consistent with previous studies that reported lower bowel screening uptake among more disadvantaged or remote areas in Australia [ 6 , 14 , 31 ] and globally. [ 8 , 12 , 32 ] That these patterns were evident across three non-overlapping consecutive time-periods indicates the stability of these associations. A unique feature of this study was the ability to examine how screening participation varied not only between but also within these broader categories ( S6 Fig ).…”

Section: Discussionmentioning

confidence: 92%

Geographical and spatial variations in bowel cancer screening participation, Australia, 2015–2020

et al. 2023

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Background Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015–2020. Methods Publicly available population-level participation data for Australia’s National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019–2020 compared to the national average, and during 2015–2016 and 2017–2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test. Results Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019–2020. Conclusions Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.

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“…Increasing participation in the Australian NBCSP has the potential to reduce bowel cancer incidence and reduce associated health costs over 20 years [ 7 ] and bring the Australian screening programme in line with international bowel cancer screening programmes which have much higher participation rates of 60–70% [ 24 ]. This is one of the health priorities of the Australian Government.…”

Section: Discussionmentioning

confidence: 99%

SMARTERscreen protocol: a three-arm cluster randomised controlled trial of patient SMS messaging in general practice to increase participation in the Australian National Bowel Cancer Screening Program

McIntosh,

Emery,

Wood

et al. 2023

Trials

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Background Australia persistently has one of the highest rates of colorectal cancer (CRC) in the world. Australia’s National Bowel Cancer Screening Program (NBCSP) sends a biennial Faecal Immunochemical Test (FIT)—the ‘NBCSP kit’—to everyone eligible for the programme between 50 and 74 years old; however, participation in the programme is low, especially in the 50- to 60-year-old age group. Our previous efficacy trial (‘SMARTscreen’) demonstrated an absolute increase in uptake of 16.5% (95% confidence interval = 2.02–30.9%) for people sent an SMS with motivational and instructional videos, from their general practice prior to receiving their NBCSP kit, compared to those receiving usual care. Building on the strengths of the SMARTscreen trial and addressing limitations, the ‘SMARTERscreen’ trial will test the effect on participation in the NBCSP of sending either an SMS only or an SMS with online video material to general practice patients due to receive their NBCSP compared to ‘usual care’. Methods SMARTERscreen is a three-arm stratified cluster randomised controlled trial involving 63 general practices in two states in Australia. Eligible patients are patients who are aged 49–60 years and due to receive their NBCSP kit within the next 2 weeks during the intervention period. General practices will be equally randomised to three trial arms (21:21:21, estimated average 260 patients/practice). The two interventions include (i) an SMS with an encouraging message from their general practice or (ii) the same SMS with weblinks to additional motivational and instructional videos. The control arm will receive ‘usual care’. Using the intention-to-treat approach, primary analysis will estimate the three pair-wise between-arm differences in the proportion of eligible patients who participate in the NBCSP within 6 months of when their kit is sent, utilising screening data from the Australian National Cancer Screening Register (NCSR). Patient intervention adherence to the interventions will also be evaluated. Findings will be incorporated into the Policy1-Bowel microsimulation model to estimate the long-term health benefits and cost-effectiveness of the interventions. Discussion SMARTERscreen will provide high-level evidence determining whether an SMS or an SMS with web-based material sent to general practice patients prior to receiving their NBCSP kit increases participation in bowel cancer screening. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12623000036617. Registered on 13 January 2023. Trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385119&isClinicalTrial=False

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What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

Cited by 5 publications

References 44 publications

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit

Geographical and spatial variations in bowel cancer screening participation, Australia, 2015–2020

SMARTERscreen protocol: a three-arm cluster randomised controlled trial of patient SMS messaging in general practice to increase participation in the Australian National Bowel Cancer Screening Program

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