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. In the meantime, results have been published in peer-reviewed journals, as listed below.

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 Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary 1-week follow-up for primary outcome 

Journal Citations

Article Highlight: For older adults, guidelines recommend clinicians and patients work together to make decisions about colorectal cancer screening (CRC). However, these conversations must consider several factors and can be challenging. This study compared two ways to help clinicians and older patients make colorectal cancer screening decisions. The objective of the study was to promote shared decision making for CRC testing decisions among older patients. In results appearing in an August 2022 issue of the Journal of General Internal Medicine, the research team found that physician training plus electronic reminders when patients are eligible for a discussion about screening increased shared decision making and frequency of colorectal cancer testing discussions in an age group where shared decision making is essential.

Project Information

Karen Sepucha, PhD
Massachusetts General Hospital
$2,526,703
A Randomized Trial to Promote Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)

Key Dates

August 2018
May 2023
2018

Study Registration Information

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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: September 14, 2022