Table 1 Main studies/interventions conducted and main results achieved during the experimental phase conducted by the Lazio Regional Public Health Authority.

To describe GPs' the knowledge, attitudes and recommendations about colorectal cancer screening.

Survey of the GPs [18]

24% of the GPs correctly recommended screening for CRC; 22% did not recommend any; 6% under-recommended and 47% over-recommended. 22% of GPs recommended inappropriate follow up tests for patients with positive FOBT.

To describe attitudes and recommendations about colorectal cancer screening of the endoscopy centre physicians.

Survey of the endoscopy center's physicians [19]

Colonoscopy was perceived as the most effective screening test and was the most recommended (80%). FOBT was recommended by 61% of physicians and flexosigmoidoscopy by 11%. 50% over-recommended screening.

To evaluate the effect of the provider (GPs versus hospital) on compliance FOBT screening.

Randomised controlled trial [20]

24.5% of 1192 GPs agreed to participate in the trial. The compliance with the GP was 54% vs 17% with the hospital (RR 3.4; 95%IC 3.1–3.7). There was a high variability in the compliance obtained by the GPs. GPs with more than 25 patient visits per day and those who incorrectly recommended screening had lower compliance (OR 0.74, IC95% 0.57–0.95 and OR 0.76, IC95% 0.59–0.97, respectively).

To assess the effect of the type of FOBT, Guaiac or immunochemical, on compliance.

Cluster-randomised trial [21].

The immunochemical test (OC-Hemodia, Eiken) had a compliance of 35.8% and the Guaiac of 30.4% (RR 1.20; CI95% 1.02–1.44). The Guaiac test had a higher prevalence of positives (10.3% vs 6.3%); and had higher variability in the results.

To identify determinants of non-compliance to FOBT screening.

Case-control study nested in the trial [22].

About 31% of non-compliant people reported never receiving the letter offering free screening; 17% of the sampled population had already been screened. The major reason for non-compliance was "lack of time" (30%), the major determinant of compliance was the distance from the test provider: OR > 30 minutes vs < 15 minutes 0.3 (95%CI = 0.2–0.7).

To define criteria for a quality assurance program for CRC screening endoscopy.

A multidisciplinary panel consensus

A system of quality indicators was created: protection of "users" rights; location in which endoscopy is performed; medical and non-medical staff skills and training in colonoscopy and screening procedures; availability of CRCS-specific management protocols; technical and professional processes; early outcomes evaluation; adverse effects and follow-up management.

To estimate increase in colonoscopies resulting from screening.

Analysis of administrative databases.

Assuming a FOBT positivity rate of 3.5%, a 50% compliance rate, we estimated that nearly 50% more colonoscopies would be required.