ORIENT

Colorectal cancer (CRC) is one of the top three most common cancers worldwide. In 2020 alone, it led to nearly 1.9 million new cases and was responsible for 930,000 deaths, with the highest numbers reported in Europe. 

Screening tests are available and have been very effective in reducing the number of people getting sick from this cancer. However, in Flanders, only about half of the people invited to get screened take the test. This number is even lower among people with: 

• Low socio-economic status (about 28%), and 
• Non-Belgian nationals (between about 15% and 34%). 

These groups face barriers such as fear of the procedure, limited health literacy and language proficiency in Dutch, and doubts whether they can perform the test. 

European guidelines emphasize the importance of making an informed choice about CRC screening, highlighting a gap that shared decision-making (SDM) tools aim to fill. They suggest using tools designed to help people decide together with their doctors if screening is right for them. However, the tools we have right now were mostly developed in the United States and might not fit with what people in Flanders need because of the significant difference in population characteristics, healthcare systems and policies. 

ORIENT aims to develop and pilot-test a risk-stratified SDM tool for CRC screening that is tailored to the needs of vulnerable populations and general practitioners (GPs) in Flanders, Belgium. This tool combines the use of:

• a video-based decision aid that the individuals can view to have a basic understanding about colorectal cancer and screening, and 
• an individualized risk estimator for CRC that GPs can use to calculate and convey their patients' risk of developing CRC.

To ensure the tool fits the local context, we collaboratively developed it with input from patients, general practitioners, and experts in Flanders, continuously refining it based on their feedback. Currently, the tool is being tested in GP practices to examine its feasibility in facilitating the SDM process and to determine its potential to improve informed choices and increase screening intentions among vulnerable populations. 
 

To develop and test a personalized SDM tool for CRC screening that can:

• be easily comprehended by individuals with low (health) literacy and those who do not mainly speak Dutch,
• enhance knowledge and understanding of CRC and CRC screening among low literacy and migrant populations,
• help elucidate what really matters to them when considering CRC screening, and
• improve communication between GPs and vulnerable patients about CRC screening by providing balanced information on the benefits and risks, ensuring that their possible participation is one through an informed choice, based on evidence and in line with their values, preferences and personal risk factors. 

Evidence synthesis
Findings from two systematic reviews reported that SDM tools are effective in improving knowledge, reducing decision conflict, and increasing intentions to get screened for cancer. This is even more effective for vulnerable populations. However, it is important that these tools are developed collaboratively with input from both healthcare professionals and patients to make sure it works well for both. Additionally, even though we have risk prediction models to figure out who might be at higher risk for CRC, we need to be clearer about how these methods work and how they can be used in real life to help with screening. If you are interested in learning more about the results of our reviews, you can find the detailed reports on this website. 

Risk-stratified SDM tool
Our project has achieved a few important things. Firstly, we created a personalized SDM tool that integrates a CRC risk estimator (artificial intelligence) and insights from stakeholder consultations. We also made a video that talks about colorectal cancer (CRC), explaining how people can get screened, and highlighting why it is important to make informed choices. This video is available in many subtitled languages to make sure more people can understand it.

In our discussions with vulnerable populations in Flanders, we found something interesting. These groups thought that getting a false positive result (where a test says you might have a disease when you really do not have it) could be good news. They felt that the video, which had subtitles in different languages and was spoken slowly, was easy to understand. The feedback showed us that our tool could really help in making decisions together with doctors, especially for underserved groups. However, we need to do more tests to make sure this tool works well in GP practices.