Background: Polygenic risk scores (PRS) can predict an individual’s risk of colorectal cancer (CRC) enabling tailoring of screening. The SCRIPT trial tested a complex intervention, including a PRS, in general practice to increase risk-appropriate CRC screening completion. Methods: This was a stratified, individually randomised controlled trial in eight general practices in Victoria, Australia. Patients aged 45-70 were consecutively approached for participation. For those over 50, those due CRC screening were eligible. The SCRIPT intervention comprised a CRC PRS, risk-tailored screening recommendations, and a risk report provided in a consultation and sent to participants’ GP. Control consultations included a discussion and brochure focused on lifestyle CRC risk factors.The primary outcome was the proportion completing risk-appropriate CRC screening by 12 months. In the SCRIPT arm, risk-appropriate screening was defined using PRS- and family history-derived CRC risk; in the control arm, it was defined using family history criteria. National screening guidelines, timing, type and results of previous screening were considered in both arms. Outcome assessors were blind to allocation (no other blinding was possible). Findings: Between 19/04/2021 and 23/08/2022, 276 participants (66% of those eligible) were randomised (138 control, 138 intervention). Three were withdrawn (one in each arm deemed ineligible, one control participant withdrew all data). Intention-to-treat analysis included 137 intervention and 136 control participants. In the SCRIPT arm, 62.8% (n=86) completed risk-appropriate CRC screening within 12 months, compared to 47.8% (n=65) of control participants – an increase of 14.9% (95% confidence interval: 3.5%-26.4%, p=0.012). Interpretation: This is the first trial to show that personalised genomic cancer risk information can be effectively incorporated into a primary care intervention to increase appropriate cancer screening completion. This is a key finding for effective implementation of risk-stratified population cancer screening – ensuring the correct screening is recommended, while optimising participation.

Abstract Background The use of antidepressants is increasing globally. Despite their obvious benefits, ongoing use of these medications is often not properly monitored or deprescribed when a person returns to better mental health. In addition, providing prescriptions to those who do not have clinical depression leads to personal and societal cost burdens. Objective This trial aims to assess the clinical effectiveness and cost-effectiveness of an online support tool designed to help patients with mild to no symptoms of depression and their general practitioners manage the careful and appropriate tapering and cessation of antidepressants at 6 months, and compare the effectiveness to that of usual care. Methods This stratified, single-blind, parallel, 2-arm, superiority randomized controlled trial includes Australian primary care patients (aged 18-75 years) with mild to no symptoms of depression who have been on antidepressant medication for longer than 12 months. After obtaining informed consent, 340 eligible patients will be randomized in a 1:1 ratio to an active intervention arm and an attention control arm, with stratification by general practice or state of residence, if recruited via social media. Those in the active intervention arm will be asked to reduce their antidepressant use with the aid of a clinically guided online support tool (WiserAD), while those in the attention control arm will continue to receive usual care. Participants in both arms will be provided with information about antidepressants through the Beyond Blue website and followed up at 3, 6, 12, and 18 months to record antidepressant use, depression and anxiety symptom severity, quality of life, and health economic data. An intention-to-treat analysis will determine the clinical effectiveness of the online tool compared with usual care. The primary outcome is the between-arm difference in the proportion of participants who successfully cease medication use at 6 months and have mild or absent depressive symptoms. Cost-consequence and cost-utility analyses will be used to determine the cost-effectiveness of the intervention and its impact on quality of life, and comparisons will be made with usual care. Results The study was funded by the National Health and Medical Research Council in 2019. At submission of this manuscript in July 2025, 310 participants have been randomized, and recruitment ongoing. The target number of 340 randomized participants was achieved in January 2026. Trial outcomes will be reported in peer-reviewed journals in Febraury 2027. Conclusions The WiserAD online support tool assists patients and their general practitioners with deprescribing and may lead to successful cessation of antidepressant medication, resulting in enhanced quality of life and cost savings over the longer term.

BACKGROUND AND OBJECTIVES:General practitioners' (GPs') confidence in caring for adolescents was explored using data from a randomised controlled trial of an adolescent health assessment.​ METHOD: GPs completed an online survey. Using descriptive analyses, we assessed confidence with: (1) consulting with adolescents; (2) managing confidentiality; and (3) discussing different aspects of health. Requests for further resources were recorded. RESULTS:Most GPs were female (60.6%) and aged 31-59 years (80.3%). GPs were more confident consulting with patients aged 18-24 years (high confidence: 69.7%) versus those aged 14-17 years (50.0%; P = 0.011). Regarding patients aged 14-15 years, only 41.7% and 22.7% of GPs were highly confident negotiating time alone and making management decisions without parents, respectively. GPs were least confident discussing gender and sexuality. Many requested further information about gender diverse identities, medicolegal issues and disruptive behaviour. DISCUSSION:This sample of GPs identified gaps in confidence and the need for additional support, particularly regarding gender and sexual diversity, medicolegal issues and privacy/confidentiality for younger adolescents.

The Richards Trauma Process (TRTP) is a novel, very brief transdiagnostic psychotherapy that uses innovative methods to work with parts of the self to reprocess traumatic memories without using exposure techniques. Our objectives were to explore the feasibility of studying this therapy in a community setting, to document the safety and acceptability of TRTP, and to gather preliminary indications of outcomes in adults presenting with elevated levels of psychological distress. This was a before-after single-arm trial of TRTP in consecutive new adult clients presenting to a psychotherapist in Australia. Inclusion criteria were at least mildly elevated levels of depression, anxiety, stress or trauma symptoms; no previous diagnosis of psychosis, Bipolar Disorder or Personality Disorder; and ability to maintain sobriety during the therapy. Feasibility was assessed against 15 criteria relating to 5 broad objectives, evaluating: (1) recruitment and retention capability, (2) data collection procedures, (3) resourcing, (4) acceptability and safety of TRTP, and (5) change in scores. Regarding objective 5, we estimated the mean change in scores on the Depression, Anxiety and Stress Scales (DASS21) and PTSD Checklist for DSM-5 (PCL-5) between follow-up and baseline; and to check for harms (objective 4) we used descriptive statistics to look for clinically meaningful deterioration in individual scores or participants. Of 40 new clients, 23 (58

OBJECTIVE:To describe characteristics, service use and clinical changes among people who received treatment through Australia's Better Access programme. METHODS:We re-analysed data from the usual care arms of two randomised controlled trials of tailored care approaches for depression and anxiety in primary care (Target-D, 2016-2019; Link-me, 2017-2019). Participants completed measures of depression and anxiety symptoms, quality of life and days out of role due to psychological distress over 12 months. They reported the use of mental health services from different providers/settings; from this, we classified a subset as likely Better Access treatment users. RESULTS:Of 394 Target-D and 547 Link-me participants, one-third were classified as having used Better Access treatment sessions over 12 months. They used five to seven Better Access sessions on average; half to two-thirds paid out-of-pocket costs (median $78-$89 per session). The number of Better Access sessions and other mental health services they used increased with severity of mental health problems. At baseline, Better Access treatment users reported more severe symptoms and more days out of role than those who used other or no mental health services, and poorer quality of life than those who used no services. Approximately half (43-55%) of Better Access treatment users showed improvements in mental health over 12 months. Among those with severe problems, improvements in depression and anxiety symptoms were associated with using 5+ Better Access sessions. CONCLUSIONS:Better Access treatment is used by people with different levels of mental health need. Many experience improvements in their mental health and functioning.

BACKGROUND:Suicide is a leading cause of death among young males in Australia. Tomorrow Man's "Breaking the Man Code" workshops aim to challenge potentially harmful masculine norms and promote positive attitudes towards help-seeking among adolescent boys in schools. METHODS:Our stratified cluster randomized trial was undertaken with 1225 boys (mean (SD) age = 15.04 (0.74) years) across 24 Australian secondary schools: 13 randomized to intervention, 11 to waitlist control. Primary outcome was mean change in intentions to seek help for personal or emotional problems 4 to 8 weeks from baseline. Secondary outcomes included conformity to masculine norms, depression risk, perceived social support, and quality of life. Purpose-designed closed-ended questions captured other behavioral and attitudinal changes. The trial was prospectively registered with ANZCTR. RESULTS:Estimated mean change in scores from baseline between the two groups on the primary outcome was -0.07 (95% confidence interval: -1.75, 1.62; p = 0.937). Purpose-designed questions revealed increased help-offering, connection with friends, and some potential barriers to change. CONCLUSIONS:Further research is needed to understand the impacts of school-based interventions for boys. TRIAL REGISTRATION:Prospectively registered with ANZCTR: ACTRN12620001134910.

Background Depression affects over 280 million people worldwide and is a leading contributor to disease burden in Australia, where most patients are managed in primary care. Although antidepressants are recommended for moderate-to-severe depression, up to half of patients do not respond to their first medication. Pharmacogenomic testing of CYP2C19 and CYP2D6 genotypes has been proposed to guide antidepressant prescribing, but evidence of their effectiveness from primary care settings is scarce. The aim of this trial was to test the effect of a pharmacogenomic-informed antidepressant-prescribing report on depressive symptoms at 12 weeks in primary care. Methods This double-blind, two-arm, stratified, randomised controlled trial was conducted in 19 general practices in Victoria, Australia. Adults aged 18–65 years with moderate-to-severe depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) and an upcoming appointment with a participating general practitioner (GP) within 2 days of being approached for participation in the trial were eligible. Participants were randomly assigned (1:1) to have their GP receive a prescribing report with four to six recommended antidepressants and respective dosage based either on the Australian Therapeutic Guidelines (control intervention) or CYP2C19 and CYP2D6 genotype-predicted phenotypes (experimental intervention). In the intervention reports, if there were no pharmacogenomic-specific recommendations for a patient, guidance was also based on Australian Therapeutic Guidelines. The primary outcome was the between-group difference in mean change in PHQ-9 score from baseline to 12 weeks. Analyses were conducted by intention-to-treat. This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12621000181808) and is completed. Findings Between May 26, 2021, and Sept 28, 2023, 552 participants were randomly assigned. Two participants withdrew after randomisation (one in each group), leaving a final intention-to-treat cohort of 550 participants (275 in each group); 168 men, 368 women, and 14 non-binary or gender diverse participants who were predominantly of European (n=452; 82%) or Asian ethnicity (n=56; 10%). At 12 weeks, 479 (87%; n=235 intervention, n=244 control) reported their PHQ-9 for the primary outcome. Both groups improved compared with baseline, but the control group showed a slightly greater reduction in PHQ-9 scores (mean change from baseline: intervention group –3·45, control group –4·63; between-group difference 0·90, 95% CI 0·06–1·75; standardised mean between-group difference 0·23, 0·02–0·45; p=0·036). There were no serious adverse events or deaths, and one grade 1 adverse event related to mishandling of a prescribing report by a general practice. Interpretation Pharmacogenomic-guided antidepressant prescribing did not improve depression severity compared with prescribing reports based on national clinical guidelines in Australian primary care, and cannot be recommended for implementation. Better approaches are needed to ensure pharmacogenomic results are accessible at the point of prescribing, and to identify if particular subgroups of patients with depression treated in primary care could benefit. Funding Australian Medical Research Futures Fund.

Children living in regional and rural Australia have diminished health outcomes and are more likely to be developmentally vulnerable on one or more domains compared to urban peers. Despite this, children in regional and rural Australia often cannot access specialist care due to lack of availability, financial constraints, or waiting times of over 12 months. Strengthening Care for Rural Children (SC4RC) aims to evaluate an integrated general practitioner (GP)–paediatrician model of care in rural communities to enhance the quality of paediatric care by ensuring children receive timely, accessible care within their communities by reducing referrals to public and private paediatric services. SC4RC is a stepped-wedge randomised controlled trial of 22 general practice clinics in regional and rural Victoria and New South Wales, Australia. Control data for each general practice clinic will be collected for a minimum of 1 month and each clinic will be randomly allocated a start month, with the intervention running for 11 months at each clinic. The intervention will consist of fortnightly GP–paediatrician co-consultation sessions, weekday phone and email paediatrician support for GPs, and access to a paediatric online community of practice via a Project ECHO™ series. The primary outcome is the proportion of paediatric (0 to <18 years) GP appointments that result in a referral to a paediatric service (hospital emergency departments, outpatient clinics, or private paediatricians) during the intervention period compared with the control period. Secondary outcomes include GP quality of care across 17 common childhood conditions, GP confidence in paediatric care, family confidence in GP care, and the sustainability of the SC4RC model. Integral to the project is our consumer engagement framework which will inform the translation and implementation of the project. An implementation evaluation will assess the acceptability, adaptability, and scalability of the model, whilst a health economic evaluation will measure the cost-effectiveness/benefit of the intervention. This protocol paper outlines how we will partner with primary care organisations and paediatric services to implement and evaluate SC4RC in some regional and rural communities in Victoria and NSW. Australia New Zealand Clinical Trials Registry ACTRN12623000550606. Registered on 23 May 2023.

Background The Australian National Bowel Cancer Screening Program sends an immunochemical faecal occult blood test to Australians aged 50-74 years to screen for bowel cancer, but uptake is low (40.9%). The SMARTscreen trial demonstrated that sending a short messaging services (SMS) prompt from the participant's general practitioner (GP) increased the proportion of kit returns by 16.5%. This research aimed to determine the acceptability and feasibility of implementing SMARTscreen.Method SMARTscreen was a cluster randomized controlled trial set in 21 Australian general practices in regional Australia. Participants and general practice staff involved in the trial were included in this study. Acceptability and feasibility were measured quantitatively by calculating proportions of the SMS received, viewed, or opted out of, and qualitatively by interviewing people who sent and received the SMS.Results Of 2914 SMS sent, 2645 SMS (91%) were received by participants, 1128 (43%) people opened the weblink, and 59 (2%) people opted out of receiving future SMS. Interviews with general practice staff (n = 17) and participants (n = 18) found that sending and receiving the SMS was acceptable and feasible. The SMS was considered a low-burden activity that easily integrated into the clinic's workflow without impacting clinicians' time. Participants reported an increased intention to participate in screening, but some people worried the weblink was spam, and some suggested sending it out of working hours.Conclusion The SMS-based intervention was widely accepted by GP staff and participants. Future research should test the SMS with and without the weblink, and send the SMS at a more convenient time of the day/week.

Background Gonorrhoea notification rates in Australia have more than doubled between 2014 and 2019. We explored gonorrhoea testing patterns and management of gonorrhoea infection in general practice. Methods We analysed de-identified electronic medical record data for individuals who attended 73 Australian general practices (72 in the state of Victoria) between January 2018 and December 2020. The 'care cascade' model was utilised to explore gonorrhoea detection and management. Descriptive analysis and logistic regression were used to investigate factors associated with gonorrhoea testing, treatment and retesting. Results During the study period, there were a total of 1,027,337 clinical episodes. Of these, 5.6% (n =57,847, 95% confidence interval [CI] 4.5-6.7) involved a gonorrhoea test and 1.1% (n =637, 95% CI 0.8-1.4) tested positive. Of the 637 gonorrhoea cases, 48.4% (n =308, 95% CI 29.8-67.0) had an Australian guideline-recommended dual antibiotic prescription (ceftriaxone and azithromycin) recorded. Of 329 cases without a dual antibiotic prescription, 84.2% (n =277, 95% CI 77.5-90.9) had reattended the clinic. Among the 206 gonorrhoea cases with dual antibiotic prescription recorded in 2018 and 2019, 32.0% (n =66, 95% CI 25.3-38.8) were retested from 6weeks to 6months post-treatment. Of the 140 gonorrhoea cases that were not retested, 54.3% (n =76, 95% CI 46.8-61.8) reattended the clinic within 6months of treatment. Conclusion The low proportion of gonorrhoea cases prescribed recommended antibiotics and retested within recommended timeframes suggests opportunities for integrating Australian STI guidelines into primary care. Further exploration of care pathways is warranted to determine if care was provided but not recorded, provided elsewhere or not provided.

Clinical prediction models are rapidly gaining recognition as valuable tools for enhancing decision-making in family practice. This is driven by the increasing availability of high-quality, routinely collected data. This paper offers a practical introduction to developing clinical prediction models using family practice data, presenting a clear, step-by-step framework that covers key stages from defining objectives to planning implementation. By clarifying the development process, it aims to empower family physicians and family practice researchers with the foundational knowledge needed to engage in model development and contribute to tools that improve patient outcomes through accurate, timely, and personalized patient care.

Elevated suicide rates among adolescent boys in Australia reflect a critical need to address restrictive masculine norms that hinder help-seeking. Tomorrow Man's 'Breaking the Man Code' workshop-a school-based gender transformative programme-aims to increase authentic self-expression and meaningful dialogue among adolescent boys. Evidence of the impacts of gender transformative programmes is limited. Within a cluster randomized trial, 183 boys (Years 10 upwards) from 11 Australian schools completed open-ended survey questions about their experiences of the 'Breaking the Man Code' workshop and its perceived impact on help-seeking with friends and family. Data were analysed using reflexive thematic analysis. Three themes were developed: (i) the workshop normalized struggle and strengthened connection, creating a safe space for self-expression and peer connection; (ii) defining the 'man code' postworkshop: many participants expressed desires for increased self-expression and to support others; and (iii) talking openly with friends and family postworkshop. Greater relational impacts were described with friends, including increased compassion, trust, connection, and use of active listening skills. Perspectives within themes varied: while many discussed positive attitudinal and behavioural change, others reported no changes. The lack of reported change was largely attributed to pre-existing open communication practices; others gave no explanation; some noted difficulties implementing changes. Future research should further explore varied impacts among diverse boys. Analysis suggests that many adolescent boys in this sample desired and perceived that they could shift towards a positive masculinity characterized by deeper social connections, providing examples of this change within their relationships with friends and family postworkshop.

Hepatocellular carcinoma (HCC) incidence and mortality rates are increasing at a greater pace than any other cancer in Australia. Cirrhosis is the major risk factor for HCC, and early detection of HCC through surveillance of people with cirrhosis can improve outcomes. However, cirrhosis is under-detected in primary care settings, with 60

Background Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). Objective This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). Methods General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Results Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. Conclusions FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial Registration ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119

Sexual violence (SV) and intimate partner violence (IPV) are common in higher education settings. This study explored overlaps between lifetime SV and fear of partner (as a proxy for probable IPV) in a university sample and identify associations with mental health issues, sexual and reproductive health factors and risk-taking behaviours. Data were collected via a cross-sectional online survey with a representative sample of university students in Victoria, Australia. Findings suggest that a higher proportion of students who had experienced SV had also experienced fear of an intimate partner. Students who had experienced both sexual violence and fear of partner were more likely to report poor mental health, have increased risk-taking behaviours and higher risk of sexually transmitted infections and unplanned pregnancies compared with students who had experienced either form of violence alone. The higher education sector could place greater emphasis on interventions and strategies to reduce IPV, alongside SV.PRACTICE IMPACT STATEMENTThis study shows that university students who have experienced sexual violence are more likely to also have been afraid of an intimate partner, suggesting that for many, sexual assault may occur in the context of a relationship. Our findings also indicate that students who experience both sexual violence and fear of partner can experience worse health outcomes and engage in more risk-taking behaviours than those who experience either sexual violence or fear of partner alone. The higher education sector could place greater emphasis on sexual violence in the context of intimate relationships in primary prevention and responses.

Background Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses. Aim This trial aimed to evaluate the effectiveness of Future Health Today (FHT) - a technology that provides clinical decision support, auditing, and quality-improvement monitoring - on the appropriate follow-up of patients at risk of undiagnosed cancer. Design and setting Pragmatic, cluster randomised trial undertaken in general practices in Victoria and Tasmania, Australia. Method Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record, and used demographic information and abnormal test results that are associated with a risk of undiagnosed cancer (that is, anaemia/iron deficiency, thrombocytosis, and raised prostate-specific antigen) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series, and ongoing practice support. Using the intention-to-treat approach, the between-arm difference in the proportion of patients with abnormal test results who were followed up according to guidelines was determined at 12 months. Results In total, 7555 patients were identified as at risk of undiagnosed cancer. At 12 months post randomisation, 76.0% of patients in the intervention arm had received recommended follow-up (21 practices, n = 2820/3709), compared with 70.0% in the control arm (19 practices, n = 2693/3846; estimated between-arm difference = 2.6% [95% confidence interval (CI)] = -2.8% to 7.9%; odds ratio = 1.15 [95% CI = 0.87 to 1.53]; P = 0.332). Conclusion The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended follow-up was high, suggesting a possible ceiling effect for the intervention.

Background Australian guidelines recommend that people aged 50–70 years consider taking low-dose aspirin to reduce their risk of colorectal cancer (CRC). Aim To determine the effect of a consultation with a researcher before an appointment in general practice using a decision aid presenting the benefits and harms of taking low-dose aspirin compared with a general CRC prevention brochure on patients’ informed decision making and low-dose aspirin use. Design and setting Individually randomised controlled trial in six general practices in Victoria, Australia, from October 2020 to March 2021. Method Participants were recruited from a consecutive sample of patients aged 50–70 years attending a GP. The intervention was a consultation using a decision aid to discuss taking aspirin to reduce CRC risk while control consultations discussed reducing CRC risk generally. Self-reported co-primary outcomes were the proportion of individuals making informed choices about taking aspirin at 1 month and on low-dose aspirin uptake at 6 months, respectively. The intervention effect was estimated using a generalised linear model and reported with Bonferroni-adjusted 95% confidence intervals (CIs) and P -values. Results A total of 261 participants (86% of eligible patients) were randomised into trial arms ( n = 129 intervention; n = 132 control). Of these participants, 17.7% ( n = 20/113) in the intervention group and 7.6% ( n = 9/118) in the control group reported making an informed choice about taking aspirin at 1 month, an estimated 9.1% (95% CI = 0.29 to 18.5) between-arm difference in proportions (odds ratio [OR] 2.47, 97.5% CI = 0.94 to 6.52, P = 0.074). The proportions of individuals who reported taking aspirin at 6 months were 10.2% ( n = 12/118) of the intervention group versus 13.8% ( n = 16/116) of the control group, an estimated between-arm difference of −4.0% (95% CI = −13.5 to 5.5; OR 0.68 [97.5% CI = 0.27 to 1.70, P = 0.692]). Conclusion The decision aid improved informed decision making but this did not translate into long-term regular use of aspirin to reduce CRC risk. In future research, decision aids should be delivered alongside various implementation strategies.