Reducing outpatient visits for FIT-positive participants of colorectal cancer screening programs with home-based digital counselling

Abstract

Digital counselling can alleviate the burden on healthcare systems and patients. While it has been evaluated as a supplement to standard care or a substitute for follow-up visits, its use for initial triaging and counselling remains unstudied. We developed a Digital Intake Tool (DIT) to facilitate the entire pre-colonoscopy counselling process for FIT-positive participants of a colorectal cancer screening program digitally, replacing the need for physicians. In this multicentre prospective non-inferiority study, we evaluated if the DIT could replace in-person counselling. DIT-counselling resulted in adequately prepared participants in 96.5%, compared to 97.6% after in-person counselling, demonstrating non-inferiority. Outpatient visits were significantly reduced, with only 3.4% requiring face-to-face consultations. Patient experiences were highly positive, without increased psychological distress or anxiety, and effective knowledge transfer. This approach benefits patients and healthcare systems, allowing patients to receive care at home, reducing travel and carbon emissions, while increasing outpatient capacity. ICTRP-registration: NL9315, March 8, 2021.

Fig. 1. Participant flowchart.

The flowchart provides a schematic illustration of the recruitment and enrolment process in our study. Participants included in the intention-to-treat analysis are highlighted in blue, and participants included in the per-protocol analysis are highlighted in orange.

Fig. 2. Forest plot of non-inferiority analyses on primary study outcome.

This figure shows the risk difference in adequate bowel preparation rates, comparing DIT-counselling with in-person counselling. The dotted line indicates the −8% non-inferiority margin. Error bars represent the 95% CI. CI confidence interval.