title: The CRISP colorectal cancer risk prediction tool: an exploratory study using simulated consultations in Australian primary care.
abstract: BACKGROUND
  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.
authors.affiliation: Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3010, Australia. walker@unimelb.edu.au.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Walker
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bickerstaffe
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Nadira
authors.initials: N
authors.lastname: Hewabandu
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Maddumarachchi
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: James G
authors.initials: JG
authors.lastname: Dowty
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Jenkins
authors.affiliation: Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3010, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3010, Australia.|General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia.|The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.affiliation: Centre for Cancer Research, Department of General Practice, VCCC, University of Melbourne, Level 10, 305 Grattan Street, Melbourne, VIC, 3010, Australia.|General Practice, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia.|The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D009726:Nurses; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*
keywords: Bowel cancer screening; Cancer screening; Colorectal cancer; Colorectal cancer risk assessment; Colorectal cancer risk prediction; General practitioners; Primary care