The Colorectal cancer RISk Prediction (CRISP) trial: a randomised controlled trial of a decision support tool for risk-stratified colorectal cancer screening

Background A risk-stratified approach to colorectal cancer (CRC) screening couldresult ina more acceptable balance of benefits and harms, and be more cost-effective. Aim To determine the effect of a consultation in general practice using a computerised risk assessment and decision supporttool (Colorectal cancer RISk Prediction, CRISP) on risk-appropriate CRC screening. Design and setting Randomised controlled trial in 10 general practices in Melbourne, Australia, from May 2017 to May 2018. Method Participants were recruited from a consecutive sample of patients aged 50-74 years attending their GP. Intervention consultations included CRCrisk assessment using the CRISP tool and discussion ofCRC screening recommendations. Control group consultations focused on lifestyle CRC risk factors. The primary outcome was risk-appropriate CRC screening at 12 months. Results A total of 734 participants (65.1% of eligible patients) were randomised (369 intervention, 365 control); the primary outcome was determined for 722(362 intervention, 360 control). There wasa 6.5% absolute increase (95% confidence interval [CI] = -0.28 to 13.2) in risk-appropriate screening in the intervention compared with the control group (71.5% versus 65.0%; odds ratio [OR] 1.36, 95% CI = 0.99 to 1.86, P= 0.057). In those due CRC screening during follow-up, there was a20.3% (95% CI = 10.3 to 30.4) increase (intervention 59.8% versus control 38.9%;OR 2.31, 95% CI = 1.51 to 3.53,P<0.001) principally by increasing faecal occult blood testing in those ataverage risk. Conclusion A risk assessment and decision support tool increases risk-appropriate CRC screening in those due screening. The CRISP intervention could commence in people in their fifth decade to ensurepeople start CRC screening at the optimal age with themost cost-effective test.

Automated summary

Using a risk assessment and decision support tool can increase the rate of risk-appropriate colorectal cancer screening. It is important to start screening for colorectal cancer at the appropriate age and choose the most cost-effective testing method.