Optimizing Participation In Colorectal Cancer Screening By Direct Invitation Of Non Responders By General Practitionners (OPTIDEC COLO)

In year n, the 50 selected general practitioners will receive a list of patients who are not up to date with colorectal cancer screening from the national health insurance. Each patient's screening status will be verified by the clinical research associate through a review of the medical records. A telephone call will then be made by a member of the patient's primary care team.

A telephone call will be made by a member of the patient's primary care team (general practitioner, medical secretary, public health nurse, or care coordinator), with priority given to a call by the patient's general practitioner. The call should preferably be made to the patient's mobile phone. If the call is unsuccessful, a voicemail message will be left, and a second call will be attempted within the following seven days. The voicemail message will include the name of the patient's general practitioner, the purpose of the call regarding colorectal cancer screening, and notification that a further attempt will be made to reach the patient. If the telephone exchange is successful, an appointment at the healthcare facility will be offered to the patient, during which the screening test will be handed over and explained by one of the healthcare professionals from the same facility.

In year n, the 50 selected general practitioners will receive from the national health insurance a list of patients who are not up to date with colorectal cancer screening. Each patient's screening status will be verified by the clinical research associate through a review of the medical records. There will be no intervention.

Patients who completed the colorectal cancer screening test during the intervention year (year n), within the patient population of general practitioners participating in the study, and who were identified from the national health insurance list as not up to date with screening, a status that was confirmed by reviewing their medical records. Completion of the screening will be confirmed by the presence of the test result in the patient's medical record within the general practitioner's practice software, no later than three months after the end of the intervention. This measure will be applied in each arm

Patients whose colorectal cancer screening status changed between the list received from the National Health Insurance in year n and the list received in year n+1. This change in status will be confirmed by the absence of the patient from the n+1 list, among those still registered within the general practitioner's patient panel.

Patients who completed the colorectal cancer screening (CRC) test during the intervention year, within the patient population of general practitioners participating in the study, and who were identified from the national health insurance list as not up to date with screening. This proportion will be analysed according to the following stratification variables:

• Patient-related variables: age, sex
• Territorial variables: level of urbanisation, deprivation index, participation rate in CRC screening in 2023
• General practitioner-related variables: age, sex, solo vs. group practice
• Caller status: profession of the person who made the call

In both study arms, identification of patients incorrectly included in the national health insurance list (i.e., patients already up to date with screening, those excluded from CRC screening, those under or awaiting colonoscopic follow-up, or currently undergoing treatment for colorectal cancer).

For the intervention arm, classification of all patients according to the following outcomes:

• Patients contacted
• Patients who refused screening
• Patients who accepted to participate
• Patients who attended the healthcare facility to collect the screening kit
• Patients for whom the test result was received by the general practitioner

In the intervention arm, time spent on all stages of the intervention:

• Processing the national health insurance list
• Making telephone calls
• Patient follow-up