Results Summary

What was the research about?

For older adults ages 76–85, clinical guidelines note that the benefits of screening for colorectal cancer, or CRC, may not outweigh the harms. For this reason, the guidelines recommend that clinicians, such as doctors and nurse practitioners, work together with patients to make the screening decisions that work best for each patient. Shared decision making, or SDM, is a process in which patients and clinicians work together to make healthcare decisions.

In this study, the research team compared two approaches to improve SDM about CRC screening for older adults:

  • Electronic alert alone. Clinicians received an email or alert in a patient's electronic health record two or three days before meeting with the patient. The alert encouraged clinicians to talk with their patients about CRC screening.
  • Clinician training plus electronic alert. Along with an email or alert, clinicians took a two-hour online training. The training had examples of SDM and helped clinicians talk with their patients about CRC screening.

What were the results?

Compared with patients in the electronic alerts alone group, patients in the clinician training and electronic alerts group:

  • Reported more SDM about CRC screening
  • Were more likely to discuss CRC screening with their clinician
  • Had more intention to follow through with their preferred type of CRC screening
  • Received more CRC screenings after one year

The two groups didn’t differ in:

  • How much patients knew about CRC screening
  • How satisfied patients were with their visit
  • How many patients received their preferred type of CRC screening
  • How confident clinicians were in their ability to do SDM
  • How often clinicians used SDM in practice sessions during training activities

Who was in the study?

The study included 466 patients ages 76–85 who were due or overdue for CRC screening. All received care from one of 67 primary care clinicians at 35 clinics in Massachusetts and Maine. Among patients, 93 percent were White, and 7 percent were non-White or Hispanic. The average age was 79, and 53 percent were women.

What did the research team do?

The research team assigned clinicians by chance to one of the two approaches.

Clinicians filled out an online survey about SDM at the start of the study and again after patient visits. Soon after their visit, patients filled out a survey about the level of SDM. The research team looked at health records to find the number of CRC screenings.

Patients, advocacy groups, and clinicians helped design the study.

What were the limits of the study?

Patient visits happened during the COVID-19 pandemic, which caused disruptions to care. Also, most patients in the study were White. Results may have differed if more patients from other racial backgrounds were part of the study.

Future research could look at ways to improve SDM with clinicians who provide care for patients from other racial backgrounds.

How can people use the results?

Health systems can use the results when considering ways to help older patients and their clinicians make decisions about CRC screening.

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.

Conflict of Interest Disclosures

Project Information

Karen Sepucha, PhD, and Leigh Simmons, MD
Massachusetts General Hospital
A Randomized Trial to Promote Informed Decisions about Cancer Screening in Older Adults (PRIMED Study)

Key Dates

August 2018
May 2023

Study Registration Information


Has Results
Award Type
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 28, 2023