Feasibility, acceptability and preliminary efficacy of implementing streamlined colonoscopy surveillance practices in South Australia for individuals who are at an increased risk for bowel cancer (the SCOPES program).

The SCOPES digital intervention aims to streamline colonoscopy surveillance through automating processes and reduce manual data entry. This will include data linkage, natural language processing, and rule-based algorithms. Natural language processing will be used to create structured data fields from unstructured colonoscopy and pathology reports. Data linkage will link together hospital electronic medical records (e.g. patient demographics and relevant clinical details, colonoscopy and pathology reports) for storage in the SCOPES clinical records. Rule-based algorithms (created based on national colonoscopy surveillance guidelines) will be used provide appropriate timings for the next colonoscopy. Digital Components: - SCOPES System: A centralised platform that consolidates patient data and flags individuals requiring surveillance. - Natural language processing (NLP): Transforms unstructured colonoscopy and pathology reports into structured data and integrates it into the SCOPES system, streamlining data entry. - Rule-Based Algorithms: Integrated into the SCOPES system to determine the timing of the next colonoscopy based on national guidelines as a decision support tool for the nurse. After the colonoscopy, using the data stored within the SCOPES system, the tailored surveillance plan will be generated and shared with the patient and their general practitioner via letter, detailing the recommended timing for the next colonoscopy based on the patient's risk profile and clinical guidelines. The SCOPES system flags patients who require colonoscopy within the next 3 months. Patients will then receive reminders (e.g., SMS, email, or letters) to arrange their next surveillance colonoscopy. The SCOPES system will automatically send surveys in the month prior and 2-3 months after Colonoscopy. Each hospital site will implement the SCOPES digital intervention for a minimum of 6 months and a maximum of 3 years, covering both the initial implementation and subsequent evaluation phases. The intervention will be deployed in a stepped wedge design, with a scheduled, sequential roll-out across the following South Australian health networks at 3 to 6-month intervals: Southern Adelaide Local Health Network: Flinders Medical Centre and Noarlunga Health Service. Northern Adelaide Local Health Network: Lyell McEwin Hospital and Modbury Hospital. Central Adelaide Local Health Network: Royal Adelaide Hospital and The Queen Elizabeth Hospital. Riverland Mallee Coorong Local Health Network: Riverland General Hospital. Port Lincoln, Eyre and Far North Local Health Network: Port Lincoln Hospital. The implementation order for each health network will follow a predetermined sequential schedule at the discretion of the lead researchers. This will be coordinated centrally and will ensure a systematic roll-out across all sites, allowing for the assessment of each stage of implementation. For each hospital, an audit of colonoscopy surveillance practices, consumer acceptability, and cost effectiveness, will be conducted before (baseline) and at least 6 months after the implementation of the intervention. - Colonoscopy surveillance practices for quality and timeliness of procedure and appropriateness of surveillance recommendation will be compared against the Australian Commission on Safety and Quality in Health Care Standards, and the NHMRC Colorectal Cancer Surveillance Guidelines. These measures include: - The prevalence of colonoscopies given surveillance recommendations that are compliant with national guidelines. Target greater than or equal to 90% - The prevalence of on-time surveillance colonoscopy bookings. Target all booked within 6 months. - The median time taken to review the colonoscopy outcomes and to communicate the recall decision with the patient and GP. Target less than 1 month - Consumer acceptability of the implementation will be assessed with surveys to evaluate satisfaction (e.g. communication speed, ease of understanding of information provided and experience of colonoscopy procedure), along with health-related quality of life measured with the validated EQ-5D-5L questionnaire. - Cost effectiveness will be assessed for direct costs (e.g. staffing time to maintain a surveillance colonoscopy program; costs for colonoscopy procedures) and indirect costs (e.g. number of complications prevented through quality and timely surveillance colonoscopies).