JMIR Publications

ABSTRACT

Background:

Australia's bowel cancer prevention guidelines, following a recent revision, are amongst the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for elderly patients. While these guidelines can help better allocated limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution, but are yet to be tested for this purpose.

Objective:

To assess whether a DA could increase adherence to Australia's new colorectal cancer screening and surveillance guidelines, and determine whether improved usability correlates with greater conformance to guidelines.

Methods:

As part of a randomised controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison to standard resources (SR) for making screening and surveillance decisions. Briefings were provided to study participants which were tailored to their level of familiarity with the guidelines. We also tested the DA's usability using the System Usability Scale (SUS).

Results:

Out of 117 participants, 80 were included in the final analysis. Using the SR, the participants achieved a median score of 10 out of 18 (IQR 7.75 – 13). The participants’ performance improved by 40% (RR 1.4, p <0.001) when using the DA, reaching a median score of 14 out of 18 (IQR 12 – 17). The DA was rated highly for usability with a median score of 90 (IQR 72.5 – 95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and higher questionnaire scores (r¬s = 0.4, p < 0.001). No differences between the performances of specialists and non-specialists were found, either with the SR (10 vs 9, p = 0.465) or the DA (13 vs 15, p = 0.242). There was no significant association between participants who performed worse with the DA (n=17) and their age (p = 0.064), experience with decision support tools (p = 0.509), or academic involvement with a university (p = 0.389).

Conclusions:

DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalised, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimise guideline concordance further. Clinical Trial: Not applicable