Introduction: This cluster-randomized controlled trial aimed to assess the effect of the “Which test is best?” tool on risk-appropriate screening (RAS) and colorectal cancer (CRC) screening uptake. Methods: General practices in Sydney and Melbourne, Australia, and a random sub-sample of 460 patients (aged 25–74 years) per practice were invited by post. Clusters were computer randomized independently of the researchers to an online CRC risk calculator with risk-based recommendations versus usual care. Primary and secondary outcomes were RAS and screening uptake via self-reported 5-year screening behaviour after 12 months follow-up. The usual care group (UCG) also self-reported 5-year CRC screening behaviour at 12 month post-randomization. Results: Fifty-six practices were randomized (27 to the intervention and 29 to the control, 55 practices participated) with 818 intervention and 677 controls completing the primary outcome measure. The intervention significantly increased RAS in high-risk participants compared with UCG (80.0% vs. 64.0%, respectively; OR = 3.14, 95% CI: 1.25–7.96) but not in average-risk (44.9% vs. 49.5%, respectively; OR = 0.97, 95% CI: 0.99–1.12) or moderate-risk individuals (67.9% vs. 81.1%, respectively; OR = 0.40, 95% CI: 0.12–1.33). Faecal occult blood testing uptake over 12 months was increased compared with the UCG (24.9% vs. 15.1%; adjusted OR = 1.66, 95% CI: 1.24–2.22), and there was a non-significant increase in colonoscopies during the same period (16.6% vs. 12.2%; adjusted OR = 1.42, 95% CI: 0.97–2.08). Conclusion: An online CRC risk calculator with risk-based screening recommendations increased RAS in high-risk participants and improved screening uptake overall within a 12-month follow-up period. Such tools may be useful for facilitating the uptake of risk-based screening guidelines.
Public Health Genomics 2022;25:193–208

中文翻译：

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哪个测试最好？风险计算器的整群随机对照试验和一般实践中结直肠癌筛查行为的建议

简介：这项整群随机对照试验旨在评估“哪种测试最好？”的效果。风险适当筛查 (RAS) 和结直肠癌 (CRC) 筛查采用率的工具。方法：澳大利亚悉尼和墨尔本的全科诊所，以及每个诊所的 460 名患者（年龄 25-74 岁）的随机子样本被邮寄邀请。集群是独立于研究人员的计算机随机分配给在线 CRC 风险计算器的，该计算器具有基于风险的建议与常规护理。主要和次要结果是 RAS 和通过 12 个月随访后自我报告的 5 年筛查行为进行的筛查。常规护理组 (UCG) 也在随机化后 12 个月时自我报告了 5 年 CRC 筛查行为。结果：56 项实践被随机分配（27 项干预，29 项控制，55 项实践参与），其中 818 项干预和 677 项控制完成了主要结果测量。与 UCG 相比，干预显着增加了高风险参与者的 RAS（分别为 80.0% 和 64.0%；OR = 3.14，95% CI：1.25–7.96），但在平均风险中没有（分别为 44.9% 和 49.5%） ; OR = 0.97, 95% CI: 0.99–1.12) 或中度风险个体（分别为 67.9% 和 81.1%；OR = 0.40, 95% CI: 0.12–1.33）。与 UCG 相比，12 个月的粪便潜血检测摄入量有所增加（24.9% 对 15.1%；调整后的 OR = 1.66，95% CI：1.24–2.22），并且同期结肠镜检查次数没有显着增加（16.6% 对 12.2%；调整后的 OR = 1.42，95% CI：0.97–2.08）。结论：带有基于风险的筛查建议的在线 CRC 风险计算器增加了高风险参与者的 RAS，并在 12 个月的随访期内提高了总体筛查率。这些工具可能有助于促进采用基于风险的筛查指南。
公共卫生基因组学 2022；25：193–208