Assessing the Feasibility and Acceptability of a Colorectal Cancer Risk Prediction Tool in Primary Care to Increase Screening Uptake in Singapore: A Multi-Methods Pilot Study.

Abstract

Colorectal cancer (CRC) screening uptake is low despite availability of population-based screening. To assess the feasibility and acceptability of an Asian-validated risk prediction tool (RPT) in increasing screening uptake. Randomised controlled trial; in-depth interviews.Method and Setting:Sixty primary care patient participants were recruited in 3 primary care practices in Singapore. Eligible patients were ≥50-year-old, with no recent CRC screening, were randomised (1:1) into control (standard recommendations) or intervention (stratified risk) groups. Follow-ups at 1 and 6 months assessed screening uptake; feasibility were evaluated through surveys. In-depth interviews were conducted with patients and their Primary Care Physicians (PCPs) to assess acceptability. Response rate of patients was 56.6%. Median age was 62.5 years. Overall, the intervention group had higher CRC screening uptake (63.3%) than control group (33.3%; <i>P</i> = .022) with use of the RPT. The tool was reported by patients to be easy to use (93.3%), questions were easy to understand (100%), words easy to see (93.3%). Logistic regression associated post-secondary education with reduced need for assistance (<i>P</i> = .042). The RPT was acceptable to patients and PCPs. Patients' perceived barriers included burdensome procedure, cost and lack of knowledge. Facilitators included intrinsic motivation and perceived early detection benefits. PCPs recognised patients' pre-determined mindset and fear of receiving bad news as barriers to screening. Education, patient empowerment and integration of RPT into workflow may aid adoption. Risk stratification of CRC using a RPT showed increased screening uptake. Future research is needed to understand which components of this complex intervention worked to bring about improved outcomes.