Review of the National Bowel Cancer Screening Program - Questions and Feedback

1

Consider feasibility of lowering screening entry age to 40 or 45 for Aboriginal and Torres Strait Islander people, coupled with scale up of the Alternative Pathway pilot for this group.

• A review of the Clinical Practice Guidelines for the prevention, early detection and management of colorectal cancer (Colorectal Clinical Practice Guidelines) is considering the clinical evidence for lowering the screening age for colorectal cancer. Implications for the Program will be considered by Government.
• The Alternative Access to Kits Model commenced in October 2022 allowing all participating health care providers to issue screening kits directly to First Nations Peoples, consistent with the original pilot.

2

Review timing intervals for reminders with clinical input.

• Currently under consideration by the Program

3

Consideration should be given to alternate forms of communication which do not require simultaneous availability of the participant follow-up function (PFUF) officer and recipient (e.g., email/SMS).

• Currently under consideration by the Program

4

Support the Australian Commission on Safety and Quality in Health Care (ACSQHC) with its implementation of the Colonoscopy Clinical Care Standard (CCCS) and monitor colonoscopy performance against colonoscopy quality standards.

• Currently under consideration by the Program

5

Work with states and territories to pilot projects that reshape the PFUF role in line with innovative colonoscopy access models.

• As part of a broader program of continuous improvement, the potential for enhancements to the Participant Follow Up Function role is under consideration by the Program.

6

Engage with Primary Health Networks (PHNs) and professional bodies (e.g., The Royal Australian College of General Practitioners and the Royal Australasian College of Physicians) to promote a comprehensive set of educational materials, which describe the NHMRC-approved clinical practice guidelines, the Program’s full alignment with biennial screening recommendations, and recent changes to the Medicare Benefits Schedule item codes for colonoscopy.

• Education material and delivery for healthcare providers is regularly reviewed, including following completion of the review of the Colorectal Clinical Practice Guidelines.

7

Re-configure Program Delivery Advisory Group (PDAG) to include jurisdictional representatives that are able to provide operational advice on contextual issues related to colonoscopy access.

• Considered as part of a broader review of governance across all cancer screening programs. No substantive changes to PDAG planned at this point.

8

Promote the Program’s research priorities to external researchers.

• The Program continues to work in partnership with researchers.
• Relevant research findings are incorporated into campaigns and used to support updates to public facing program materials.

9

Reset the working relationship with all stakeholders to ensure needs are being met in regard to the purpose of each group and expectations on information sharing.

• Targeted consultation with peak bodies and consumer advocates continues to focus on proposed programmatic changes, education and campaign materials.

10

Reconvene a working group with the goal of prioritising initiatives to address data gaps and agree on any required changes to the endorsed set of KPIs. This group should be set-up over the medium to long term to manage the stakeholder engagement, effort and time required to implement and oversee initiatives to address data gaps.

• An approach to continued improvement and capability improvement is shared across all key stakeholders involved in data holding, analysis and reporting.

11

Improve visibility of the target population’s participation in other forms of bowel cancer screening, including via over-the-counter iFOBT kits or kits provided by clinicians. Identifying invitees in the target population deemed to be at higher risk for bowel cancer (who may be undergoing surveillance colonoscopies) would also allow a more accurate measure of the true Program participation rate.

• The Alternative Access to Kits Model commenced in October 2022 allowing all participating health care providers to issue screening kits directly to patients, including under screeners.
• Methods for identifying screening occurring outside the Program is currently under consideration.

12

Implement sustained and coordinated media and communications campaigns. Campaigns should be national in nature (across jurisdictional and cancer charities, where possible) to promote a coordinated message that minimises fragmentation and duplication of effort.

• A national campaign raising awareness across multiple media platforms continues to be delivered. Campaign details are shared with states and territories to enable coordination of efforts.

13

Use the primary care sector as a resource to promote participation through education and opportunistic provision of kits. GPs, practice nurses and pharmacists are well placed to promote and provide counselling regarding Program participation.

• The Alternative Access to Kits Model commenced in October 2022 allowing all participating health care providers to issue screening kits directly to patients, including under screeners.
• GP education and awareness content for screening programs were distributed mid-2022.

14

Consider piloting sample drop-off points. Trials of this nature should initially be targeted at people in regional areas due to their unique challenges in complying with the strict return postage requirements.

• This is being considered in partnership with other Government and non-government heath outreach programs.

15

Scale up the Alternative Pathway pilot, as appropriate in other population groups. This includes other locations targeted at Aboriginal and Torres Strait Islander people, as well as exploration of how the pilot could be tailored to address access barriers faced by invitees from CALD backgrounds.

• The Alternative Access to Kits Model commenced in October 2022 allowing all participating health care providers to issue screening kits directly to First Nations Peoples, consistent with the original pilot.

16

Explore utilisation of the NCSR to improve participation. This could include electronic reminders, streamlined processes for completion of personal details, access to in-language communications, as well as personalised invitations based on Program screening history and/or demographic factors. However, given phone/email contact information is unavailable for first-time screeners, mechanisms to collect this information from other government databases, such as MyGov, may be required.

• Currently under consideration by the Program.

17

Modify kit contents and accessories to mitigate common reasons for non-completion. This may include an action plan for completion contained in the kit instructions (to overcome the procrastination barrier), and/or provision of accessories such as an opaque bag for fridge storage (to overcome perceived hygiene concerns).

• Refresh of program resources is underway.