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Project

Towards informed decisions in colorectal cancer screening (ORIENT). (ORIENT)

In Flanders (Belgian region), a colorectal cancer (CRC) screening programme has been in place since 2013 to reduce CRC incidence and related mortality1. Next to these benefits, cancer screening may cause harm for the participants such as interval cancers (CRC 16%2), a false sense of safety or anxiety due to false positives and adverse events of follow-up colonoscopy (e.g. bleeding, colon perforation). There is increasing international recognition that target groups for cancer screening have to be fully aware of the benefits and potential harms of screening in order to make an informed choice. In Flanders and a large part of the EU, this is currently not considered in full, as information shifts towards nudging the benefits of cancer screening. To what extent a person makes an informed decision about cancer screening with the given information is unknown in Flanders, as there are no measurement tools available. Additionally, there are no widespread tools that can support making an informed decision about CRC screening, such as a shared decision making (SDM) tool for general practitioners (GPs) and their vulnerable patients (both end-users in this project). GPs in Flanders have been asking for such a visual SDM tool regarding CRC screening for almost 2 years now (Personal communication, Domus medica*, 2021). At the same time, particularly the vulnerable population requires more accurate, clear and well balanced information which for them is currently not available, which could result in distrust and barriers to understanding the information (Personal communication, 10 stakeholder organisations, 2021). Therefore, the largest impact can be created for these end-users and the current health equity gap for cancer screening can be tackled. To tackle these long-lasting problems, the primary goal of this project is to develop and test an SDM tool through co-creation with the end-users tailored to their needs. Included in this tool, a personalised machine learning (AI) model will enable GPs and patients to discuss CRC on a more personal level regarding the patient's risk of CRC (risk-stratified SDM-tool). All this will be realised in the current daily practice of Flemish GPs with the support of Domus Medica. The primary outcome of the project is to assess the impact of the risk stratified SDM tool on patients' informed choice regarding CRC screening. Secondary outcomes are: 1) To assess the impact of the SDM tool on patients' attitude towards screening, intention to participate, decision conflict, confidence in decision making, anxiety about CRC and screening participation, perceptions about benefits and risk of screening and, 2) To assess GPs' experience with the SDM tool in terms of usability, time requirement, satisfaction with the tool and their perceptions about the effect of the tool on their patients. Current difficulties of reaching the vulnerable population by postal mail will be addressed via GPs. This project is considered high impact due to its scalability on the one hand and its clinical relevance towards the vulnerable population on the other. In the current CRC screening environment, this project will have an impact on the vulnerable population and through transferability of the SDM tool to the general population a possible ~ 900.000 annually invited persons could be reached. Transferability will be possible as the SDM tool will be created through Universal Design (accessible to everyone). *Domus Medica represents the interests of the general practitioners in Brussels and Flanders.
Date:15 Aug 2022 →  Today
Keywords:COLORECTAL CANCER, PREVENTIVE HEALTH CARE
Disciplines:Preventive medicine
Project type:Collaboration project