Optimizing colorectal cancer screening through quality circles of primary care physicians: a cluster randomized controlled trial.

OBJECTIVES

Colorectal cancer (CRC) screening rates are low in Switzerland. This study tested whether a PCP intervention-training sessions and performance feedback within quality circles (QC) increased CRC screening rates.

METHODS

A pragmatic randomized controlled trial was conducted in Switzerland (2018-2021) with PCP in QC. The intervention included three training sessions, shared decision-making materials, and performance feedback based on 40 consecutive patients per PCP. The primary outcome was the difference in CRC screening rates between the intervention and control group after 12 months.

RESULTS

Of 120 invited QC, nine participated (5 intervention, 4 control). A total of 63 PCPs (32 intervention, 31 control) collected data on 2,112 patients (1,130 intervention, 982 control; mean age 61.5, 53% women). Analysis clustered by PCP and QC showed screening rate was 58% in the intervention group vs. 42% in controls (OR1.98; 95% CI:1.14-3.42). Screening rates in the intervention group increased from 55% to 57.9% (absolute increase: 2.9%; 95% CI:1.1%-6.9%; OR1.29; 95% CI:1.08-1.55, p < 0.01).

CONCLUSION

Training sessions and performance feedback in QC increased screening rates, but few QCs chose to participate.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT03510858.