Project Summary  

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