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dc.contributor.authorWalker, Jennifer G
dc.contributor.authorBickerstaffe, Adrian
dc.contributor.authorHewabandu, Nadira
dc.contributor.authorMaddumarachchi,, Sanjay
dc.contributor.authorDowty, James G
dc.contributor.authorJenkins, Mark
dc.contributor.authorPirotta, Marie
dc.contributor.authorWalter, FM
dc.contributor.authorEmery, Jon D
dc.date.accessioned2018-03-29T13:28:28Z
dc.date.available2018-03-29T13:28:28Z
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/274506
dc.description.abstractBackground In Australia, screening for colorectal cancer (CRC) with colonoscopy is meant to be reserved for people at increased risk, however, currently there is a mismatch between individuals’ risk of CRC and the type of CRC screening they receive. This paper describes the development and optimisation of a Colorectal cancer RISk Prediction tool (‘CRISP’) for use in primary care. The aim of the CRISP tool is to increase risk-appropriate CRC screening. Methods CRISP development was informed by previous experience with developing risk tools for use in primary care and a systematic review of the evidence. A CRISP prototype was used in simulated consultations by general practitioners (GPs) with actors as patients. GPs were interviewed to explore their experience of using CRISP, and practice nurses (PNs) and practice managers (PMs) were interviewed after a demonstration of CRISP. Transcribed interviews and video footage of the ‘consultations’ were qualitatively analyzed. Themes arising from the data were mapped onto Normalization Process Theory (NPT). Results Fourteen GPs, nine PNs and six PMs were recruited from 12 clinics. Results were described using the four constructs of NPT: 1) Coherence: Clinicians understood the rationale behind CRISP, particularly since they were familiar with using risk tools for other conditions; 2) Cognitive participation: GPs welcomed the opportunity CRISP provided to discuss healthy and unhealthy behaviors with their patients, but many GPs challenged the screening recommendation generated by CRISP; 3) Collective Action: CRISP disrupted clinician-patient flow if the GP was less comfortable with computers. GP consultation time was a major implementation barrier and overall consensus was that PNs have more capacity and time to use CRISP effectively; 4) Reflexive monitoring: Limited systematic monitoring of new interventions is a potential barrier to the sustainable embedding of CRISP. Conclusions CRISP has the potential to improve risk-appropriate CRC screening in primary care but was considered more likely to be successfully implemented as a nurse-led intervention.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleThe CRISP Trial: an RCT of risk assessment and decision support to implement risk-stratified colorectal cancer screening in primary care.
dc.typeArticle
prism.publicationNameBMC Medical Informatics and Decision Making
dc.identifier.doi10.17863/CAM.21624
dcterms.dateAccepted2017-01-06
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2017-01-06
dc.contributor.orcidWalter, Fiona [0000-0002-7191-6476]
rioxxterms.typeJournal Article/Review
cam.issuedOnline2017-01-19


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International