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Individuals at elevated risk of developing colorectal cancer (CRC) benefit from regular surveillance colonoscopies. However, many countries lack well-managed recall processes, leading to either excessive or insufficient colonoscopy use, both of which have significant consequences. A nurse-coordinated surveillance program has been shown to improve compliance with surveillance guidelines but is associated with a costly administration burden. This study aims to create a multicenter, stepped-wedge cluster trial that will integrate digital processes into this model to optimise colonoscopy management, reduce resource burden and ensure equitable service delivery across multiple healthcare sites.

Data from colonoscopy and pathology reports will be extracted into a clinical registry and natural language processing will be used to structure the data. Rule-based algorithms (based on the Australian colonoscopy surveillance guidelines (but adaptable to other international standards), and with version control) will assess the need for future surveillance colonoscopies and recommend appropriate follow-up intervals. The accuracy of the recommendations will be evaluated by nurse coordinators, with adherence to the guidelines assessed both at baseline and 6 months post-implementation. Patient-reported measures will be collected before and during trial implementation to assess satisfaction with the surveillance processes. Outcome measures will include evaluation of guideline compliance, key performance indicators for the quality of endoscopic services and cost-effectiveness.

This trial will establish the performance, acceptability and cost-effectiveness of a digital health approach to managing surveillance colonoscopy. This will improve healthcare delivery by providing a cost-effective way to manage colonoscopy demand and to mitigate risk for CRC.