Participatory simulation modeling to inform colorectal cancer screening in a complex remote northern health system: Canada's Northwest Territories

Heather Anne Smith; Jean Hai Ein Yong; Kami Kandola; Robin Boushey; Craig Kuziemsky

doi:10.1016/j.ijmedinf.2021.104455

Participatory simulation modeling to inform colorectal cancer screening in a complex remote northern health system: Canada's Northwest Territories

Int J Med Inform. 2021 Jun:150:104455. doi: 10.1016/j.ijmedinf.2021.104455. Epub 2021 Apr 8.

Authors

Heather Anne Smith¹, Jean Hai Ein Yong², Kami Kandola³, Robin Boushey⁴, Craig Kuziemsky⁵

Affiliations

¹ Telfer School of Management, University of Ottawa, Ottawa, ON, Canada; Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada. Electronic address: hsmit037@uottawa.ca.
² Canadian Partnership Against Cancer, Toronto, ON, Canada.
³ Office of the Chief Public Health Officer, Department of Health and Social Services, Yellowknife, NWT, Canada.
⁴ Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.
⁵ Office of Research Services, MacEwan University, Edmonton, AB, Canada.

PMID: 33857774
DOI: 10.1016/j.ijmedinf.2021.104455

Abstract

Background & aims: Colorectal cancer (CRC) mortality in the Northwest Territories (NWT), a northern region of Canada, could be reduced by implementing a CRC screening program. However, this may require additional colonoscopy resources. We used participatory simulation modeling to predict colonoscopy demand and to develop strategies for implementing a feasible and effective CRC screening program in this complex remote northern health system.

Methods: Using a participatory simulation modeling approach, we first developed a conceptual model of CRC screening with local collaborators. This approach informed our parameter adjustments of an existing microsimulation model, OncoSim-CRC, using data from a retrospective cohort review of CRC screening between 2014-2019 and secondary data. Model scenarios reflecting program implementation were run for 500 million cases. Validity was assessed, and outputs analyzed with collaborators. Alternative scenarios were developed to reduce colonoscopy demand and results were presented to end-users.

Results: We estimated that colonoscopy demand with a CRC screening program phased-in over 5 years would surpass capacity within 2 years. If demand is met, screen-detected cancers would increase by 110 %, and clinically-detected cases would reduce by 26 % over the next 30 years. We also found that prolonging the phase-in period, or revising adenoma follow-up guidelines would reduce colonoscopy demand while still improving cancer detection. Both strategies were considered feasible by collaborators. The adjusted model was valid, and the projections informed local end-users plans for CRC screening delivery.

Conclusions: Using participatory simulation modeling, we projected that a screening program would improve CRC detection but surpass current colonoscopy capacity. Phasing-in the screening program and reducing endoscopic adenoma follow-up would enhance feasibility of a CRC screening program in the NWT and help maintain its effectiveness.

Keywords: Colorectal cancer screening; Health system; Participatory simulation model; Remote northern health and medicine; Simulation modeling.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / prevention & control
Early Detection of Cancer*
Humans
Mass Screening
Northwest Territories
Retrospective Studies