The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care

BMC Medical Informatics and Decision Making

Research Article

Jennifer G Walker¹  Marie Pirotta¹  Fiona M Walter²  Jon D Emery²  Sanjay Maddumarachchi³  Adrian Bickerstaffe³  Mark Jenkins³  James G Dowty³  Nadira Hewabandu³ 

[1] Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, 3010, Melbourne, VIC, Australia;Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, 3010, Melbourne, VIC, Australia;General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia;The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom;Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;

关键词: Colorectal cancer;    Colorectal cancer risk assessment;    Colorectal cancer risk prediction;    Primary care;    Cancer screening;    General practitioners;    Bowel cancer screening;   

DOI  :  10.1186/s12911-017-0407-7

 received in 2016-06-15, accepted in 2017-01-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, however, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive.This paper describes the development and optimisation of a Colorectal cancer RISk Prediction tool (‘CRISP’) for use in primary care. The aim of the CRISP tool is to increase risk-appropriate CRC screening.MethodsCRISP development was informed by previous experience with developing risk tools for use in primary care and a systematic review of the evidence. A CRISP prototype was used in simulated consultations by general practitioners (GPs) with actors as patients. GPs were interviewed to explore their experience of using CRISP, and practice nurses (PNs) and practice managers (PMs) were interviewed after a demonstration of CRISP. Transcribed interviews and video footage of the ‘consultations’ were qualitatively analyzed. Themes arising from the data were mapped onto Normalization Process Theory (NPT).ResultsFourteen GPs, nine PNs and six PMs were recruited from 12 clinics. Results were described using the four constructs of NPT: 1) Coherence: Clinicians understood the rationale behind CRISP, particularly since they were familiar with using risk tools for other conditions; 2) Cognitive participation: GPs welcomed the opportunity CRISP provided to discuss healthy and unhealthy behaviors with their patients, but many GPs challenged the screening recommendation generated by CRISP; 3) Collective Action: CRISP disrupted clinician-patient flow if the GP was less comfortable with computers. GP consultation time was a major implementation barrier and overall consensus was that PNs have more capacity and time to use CRISP effectively; 4) Reflexive monitoring: Limited systematic monitoring of new interventions is a potential barrier to the sustainable embedding of CRISP.ConclusionsCRISP has the potential to improve risk-appropriate CRC screening in primary care but was considered more likely to be successfully implemented as a nurse-led intervention.

【 授权许可】

CC BY   
© The Author(s). 2017