A Digital Intake Tool for Colorectal Cancer Screening Programmes
In the ‘Knowledge- and Innovation Agenda Health & Care’ it is stated that: ‘healthcare needs to be improved within the following three areas: prevention, translocation and substitution of healthcare’. This project aims to develop the first Digital Intake Tool (DIT) for Fecal Immunochemical Test (FIT) based colorectal cancer (CRC) screening programs and assesses effectiveness of the tool within a screening program. DIT can be performed at home, replacing health care from hospital to home.
Each year more than 2.2 million people between 55-75 years of age are invited for the national CRC screening program. Around 5%, corresponding to 77,000 screenees yearly, have a positive FIT and will be referred for colonoscopy. Currently screenees with a positive FIT need to be seen at an outpatient clinic before colonoscopy is carried out. Reason for this is to assess morbidity, risk of complications and inform patients about the procedure and CRC risk. Most of the screenees are healthy and have a working life. In this study it will be assessed if face-to-face contact can be effectively replaced by a DIT without counteracting adherence to colonoscopy, bowel cleanliness or increase patients anxiety.
This project will develop a DIT tailored for FIT positives. A DIT for CRC screening programs needs to be understandable for all people, be informative about risks and benefits and instructive. The company Informed, specialized in making animations for medical information provision to (low-literacy) patients will develop the DIT. To assess the effectiveness of the DIT for FIT-based CRC screening programs, adherence to colonoscopy, satisfaction, bowel cleanliness and anxiety of screenees will be measured. With this project we hope to facilitate screenees and health care providers, improve capacity for outpatients visits and reduce health care costs by providing a safe and validated DIT for FIT positive screenees that can be done at home.
In this prospective multicentre cohort study, we evaluated whether digital counselling could replace the traditional in-person counselling visit for FIT-positive participants of a CRC screening program prior to colonoscopy. Our findings demonstrate that the DIT is non-inferior to in-person counselling in terms of procedural preparation. A high adequate bowel preparation rate of >96% was achieved, meeting the 90% requirement of the CRC screening program. Furthermore, a substantial reduction in face-to-face outpatient visits was established, only 3.4% required face-to-face consultations, 40.9% of colonoscopies were scheduled after DIT-counselling, and in 55.7% a brief phone consultation after DIT-counselling was needed. Additionally, patient-reported experiences after digital counselling were highly positive, without any increase in psychological distress or anxiety and a highly effective knowledge transfer. Hence, digital counselling has shown to be a valuable alternative counselling technique to inform and triage patients, facilitating informed consent without direct interaction with a physician.
This approach benefits patients and healthcare systems, allowing patients to receive care at the comfort of their own home at their own time, reducing travel and carbon emissions, while increasing outpatient capacity.
This collaboration project is co-funded by the PPP Allowance made available by Health~Holland, Top Sector Life Sciences & Health, to EMC to stimulate public-private partnerships. For questions, please contact EMC directly via the following email address tki@erasmusmc.nl.
