Guido Van Hal

Ph.D.

The University of Antwerp

Professor

PLCO (Learn more about this study)

PLCO-937

Mar 7, 2022

ORIENT: tOwaRds Informed dEcisions iN colorecTal cancer screening.

In Flanders (Belgian region), a colorectal cancer (CRC) screening programme has been in place since 2013 to reduce CRC incidence and related mortality. Next to these benefits, cancer screening may cause harm for participants such as false positive or false negative tests, adverse events of diagnosis, interval cancers, anxiety or a false sense of safety. There is increasing international recognition that target groups for cancer screening have to be fully aware of the benefits and potential harms 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 the CRC screening programme, such as a shared decision making (SDM) tool for general practitioners (GPs) and their vulnerable patients (both end-users). Consequently this is the target group of this proposal, where vulnerability relates to a low socio-economic or migrant background. The largest impact can be created for these end-users and the current health equity gap for colorectal cancer screening can be tackled. GPs ask for SDM tools regarding colorectal cancer screening for almost 2 years now. While the vulnerable population requires more accurate, clear and well balanced information which for them is currently not available, resulting in distrust and barriers to understanding the information.
To tackle these long-lasting problems, the primary goal of this project is to develop and test a SDM tool through co-creation with the end-users tailored to their needs. Additionally, a personalised machine learning model is incorporated to enable GPs and patients to discuss CRC on a more personal level regarding the patient’s risk for 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.

In the current CRC screening environment this project will have an impact on ~ 900.000 annually invited persons. Current difficulties of reaching the vulnerable population by postal mail will be addressed via the 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.

*Domus Medica represents the interests of the general practitioners in Brussels and Flanders.