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  • Research & Results
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  • Comparing Two Ways to Help Clinicians...

Comparing Two Ways to Help Clinicians and Older Patients Make Colorectal Cancer Screening Decisions

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Project Summary  

COVID-19-Related Project Enhancement

The enhancement addresses important two issues: how do healthcare systems deal with the growing backlog of screening tests and elective procedures due to the pandemic and what is the impact on attitudes about COVID-19 risk, willingness to screen for colorectal cancer using alternate methods, time to screening, and barriers to screening for patients who had their colonoscopy delayed due to the pandemic.

The enhancement will compare the effectiveness of a shared decision making versus standard scheduling approach for patients on the wait list for rescheduling postponed screening and surveillance colonoscopy procedures. The results from this enhancement will build knowledge about patients’ knowledge, attitudes, and preferences for colorectal cancer screening as health care systems return to routine operations during the COVID-19 pandemic.

Enhancement Award Amount: $322,749

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Clinical guidelines recommend that adults ages 50 to 75 receive screening for colorectal cancer, or CRC. For older adults, ages 76–85, guidelines recommend that clinicians, such as doctors and nurse practitioners, and patients work together to make decisions about CRC screening, because for some older adults, the harms of screening may outweigh its benefits.

Including shared decision making, or SDM, conversations in an office visit may help ensure that older adults are knowledgeable and involved in CRC screening decisions. SDM is a process where patients and clinicians make decisions together based on the patient’s individual needs. One way to support clinicians and patients to have SDM conversations is to send clinicians an alert when a patient may need screening. But an alert may not be enough by itself. Clinicians may also need training in SDM.

In this study, the research team is comparing two ways to help clinicians and patients ages 76–85 discuss CRC screening decisions. Both ways use a system that alerts clinicians that patients are eligible for a discussion about CRC screening. One way also trains clinicians in SDM.

Who can this research help?

Clinics and clinicians can use results from this study when looking for ways to improve CRC screening decision making with older patients.

What is the research team doing?

The research team is recruiting 50 clinicians to take part in the study and 500 patients receiving care from these clinicians. Patients are ages 76–85, have an upcoming office visit, and either have never had CRC screening or need a follow-up screening.

The research team is assigning clinicians by chance to one of two groups. In both groups, an alert notifies clinicians when one of their patients ages 76–85 with an upcoming visit is due for CRC screening. The alert also shows clinicians any past CRC screening results for that patient.

In one of the groups, clinicians also complete a two-hour online SDM training. The training includes lessons, case studies, and interactive exercises on SDM. For example, the training teaches clinicians how to communicate information about cancer risk and talk to patients about their goals and concerns.

The research team is using surveys of patients, clinicians, and caregivers, and reviewing patients’ medical records for both groups to compare

  • Patient and caregiver perceptions of how much the clinician used SDM during the visit
  • Patients’ CRC screening knowledge
  • Patients’ screening preferences
  • Whether patients received their preferred screening approach
  • Clinicians’ attitudes toward SDM
  • How satisfied clinicians were with the visit
  • CRC screening rates

The research team is also assessing clinicians’ SDM skills. Clinicians in both groups are role playing a CRC screening visit by talking to a patient actor on the phone; the team is reviewing transcripts from these calls.

Patients and clinicians with expertise in primary care, geriatrics, and CRC screening and treatment are providing input at each stage of the study.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
Population
  • 50 primary care clinicians (MD or NP) from Massachusetts General Hospital, Maine Medical Center, or Partners Community Physicians Organization who manage a panel of ≥20 eligible patients
  • 500 patients ages 76–85 who are scheduled for a non-urgent office visit with a participating clinician during the study period and who are due or overdue for CRC screening
Interventions/
Comparators
  • Clinician notification

  • Clinician notification plus two-hour SDM skills training course

Outcomes

Primary: patient perception of extent of SDM 

Secondary: patient CRC screening knowledge, receipt of preferred CRC screening approach, clinician SDM skills, CRC screening rates, clinician satisfaction with visit, caregiver perception of extent of SDM, clinician attitude toward SDM

Timeframe 1-week follow-up for primary outcome 

Project Details

Principal Investigator
Karen Sepucha, PhD
Project Status
In progress; Recruiting
Project Title
A Randomized Trial to Promote Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)
Board Approval Date
August 2018
Project End Date
May 2023
Organization
Massachusetts General Hospital
Year Awarded
2018
State
Massachusetts
Project Type
Research Project
Health Conditions  
Cancer
Colorectal Cancer
Multiple/Comorbid Chronic Conditions
Intervention Strategies
Other Health Services Interventions
Technology Interventions
Training and Education Interventions
Populations
Low Income
Older Adults
Women
Funding Announcement
Communication and Dissemination Research
COVID-19-Related Project Enhancement
Project Budget
$2,526,703
Study Registration Information
HSRP20192236
NCT03959696
Page Last Updated: 
October 16, 2020

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February 2
PCORI 2021 and Beyond: Opportunities for Funding and Involvement in Patient-Centered Research
February 9
Board of Governors Meeting: February 9, 2021
February 11
Advisory Panel on Patient Engagement Winter 2021 Meeting

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