Description
Few methods for colorectal cancer screening exist, none of which is proven to be superior. The project will analyse the results of previous trials and increase colonoscopy quality. We want to assess the effect of colonoscopy screening on colorectal cancer death and incidence in Polish and Norwegian population. We want to create a digital feedback system, aiming to improve colonoscopy quality. The analysis of colonoscopy screening effects will help to address the question of preferred method of screening. Development of electronic patient feedback will improve colonoscopy quality. There will be two project outputs: the analysis of screening effects and the digital patient feedback system, implemented in all colonoscopy screening centres in Poland and Norway. The main benefit will be knowledge improvement on colorectal cancer screening. Target group is screening population – electronic feedback method should improve the colonoscopy quality. Both Norwegian and Polish representatives will tighten the collaboration in the field of colorectal cancer screening. The partnership will allow to better implement, execute and analyse the effects of such screening.
Summary of project results
Colorectal cancer is leading cause of cancer death in Europe. While colonoscopy screening is widely used in several European countries, there are no randomized trials to quantify its benefits. Recent research have shown large variability in the quality of colorectal cancer screening between hospitals and doctors, and that suboptimal quality is a significant factor for poor screening outcome and screenee dissatisfaction, which may impede screening uptake in population. Main objectives of the project were to investigate in a randomized controlled trial the effect of colonoscopy screening on colorectal cancer incidence and mortality and to develop, evaluate and implement colonoscopy quality assurance program based on digital surveys of screenees. The project was divided in 2 working packages (WP). WP1 is a follow-up study of a NordICC randomized controlled trial (NCT00883792). Within NordICC trial 68,000 men and women are drawn from the population registries and randomly assigned to either once-only colonoscopy screening, or no screening (standard of care in the trial regions). All individuals are followed for 15 years using dedicated national registries. The recruitment phase of the NordICC trial has been funded from other sources and is almost already finished. WP1 aimed at final collection and analysis of data on baseline findings, including data on unintended 30-day hospitalization rates, setting processes for a 15 year follow-up, including creation of trial endpoint committee and system for collection of data on contamination.This objective was achieved, resulting in publication in JAMA Internal Medicine (IF 14.00). WP2 consisted of setting up a minimum set of colonoscopy quality measures through systematic review of existing literature. The result of this work is a set of guidelines published in Endoscopy (IF 5.63), focusing on quality standards that should be met both on individual and centre level. WP2 aimed at development and implementation of quality assurance system based on digital surveys of screenees, performing randomized controlled trial comparing paper and electronic versions of the quality assurance system, and implementation of the electronic system in colorectal cancer screening programs in Norway and Poland. All these objectives were achieved for the duration of project and the system is working full scale in Poland and Norway for the needs of screening programs.
Summary of bilateral results
The main achievements on bilateral level include: 1. Publishing baseline results of abovementioned NordICC study and setting processes for a 15 year follow-up. Results of this study are crucial for informed decision-making on what is the most effective colorectal screening method. 2. Establishing guidelines on colonoscopy quality measures. The guidelines were published as official European guidelines, guaranteeing high impact on everyday clinical practice throughout Europe. Defining which quality measures should be of utmost importance leads to improved performance both in short- and long-term outcomes of colonoscopy. 3. Creation of digital platform aiming at patient-centred quality-assurance. Patient feedback is critical for success of population screening programs, allowing for improvement. The platform is already working full scale in Polish and Norwegian screening programs. Bilateral funds definitely strengthened the existing partnership of project partners, allowing not only for exchange of researchers for the project duration, but also allowed us to work on new projects, emerging from partnership. Also, the nature of our research implies collaboration of leading research teams in the field of screening.