Using Clinical Prompts in General Practice to Increase Participation in the National Bowel Cancer Screening Program: A Case Study Protocol
Authors: Lee S. , Bowring B. , Cooper A. , Gardiner M. 
Published: September 2018

Background: One in 12 Australians is expected to develop bowel cancer by age 85. Over 90% of bowel cancers can be successfully treated if detected early yet participation rates in the National Bowel Cancer Screening Program (NBCSP) are currently only 39%. Research shows that general practitioner (GP) recommendation is a key predictor for bowel cancer screening uptake. However the current NBCSP invitation system does not involve GPs, making it difficult for them to know when a patient has received a test kit in the mail, and in turn play a role in screening behavior. Research suggests that GP point-of-care clinical prompts, encouraging GPs to discuss screening with their patients, can increase fecal occult blood testing. Such a ´reminder´ system is integral to other screening programs in Australia, however no such system exists for the NBCSP. The George Town Medical Centre located in rural Tasmania, has recently implemented a reminder prompt for bowel cancer screening as part of its standard clinical practice. This paper describes the protocol used to implement and evaluate this service. Aim: Our research aims to determine whether a clinical prompt delivered to GPs at point-of-care, can increase bowel cancer screening participation in patients attending a rural Tasmanian general practice. Secondary aims include assessing GP and patient attitudes toward the prompt and determining socio-demographic differences in the effect of the prompt on screening participation. Methods: The clinical prompt was implemented in January 2018. Active patients turning 50 (n=106), 60 (n=141) or 70 (n=103) in 2018 were eligible to receive the prompt. The prompt was created within the practice management software and associated with each eligible patient's file. GPs were provided with information on the NBCSP as well as resources to support their conversation with patients including a sample kit. The number of patients with whom the GP discussed screening and the number of patients who completed a kit will be collected after 12 months. Screening rates of patients eligible for the prompt will be compared with patients turning 54, 64 and 74 in 2018, controlling for potential covariates including age, gender and socioeconomic status. Interviews with all GPs (n=10) and a minimum of 10 patients will be conducted to gain an understanding of attitudes toward the prompt. Results: To date the prompt has been successfully integrated into the practice and GPs have begun encouraging patients to use their NBCSP kits. Attitudes of GPs and patients toward the prompt and preliminary data on kit usage will also be presented. Conclusion: A clinical prompt in general practice may be a simple and cost effective way to increase participation in the National Bowel Cancer Screening Program. The findings from this study will have implications for the program in terms of engaging GPs in the screening invitation process. The results will further be used to inform a pilot study in Tasmania.