The rate of screening for colorectal cancer in the United States remains low (under 65 percent), meaning that thousands of people die of colorectal cancer unnecessarily. Colorectal cancer screening tests range from more invasive and very sensitive for polyps and cancer (colonoscopy) to less invasive and less sensitive (e.g., fecal immunochemical testing [FIT]). Screening rates go up when patients consider all these tests, not just colonoscopy. An individual’s chance of having an advanced colorectal neoplasm (ACN), a cancer or precancerous polyp, has direct implications for selecting a test. Colonoscopy is more effective for individuals with a higher chance of having an ACN, due to the increased chance that colonoscopy will find and/or remove one. For patients with low risk of having an ACN, noninvasive tests such as FIT are more attractive.
Our research team has developed a decision aid and provider message that discloses the patient’s current risk of ACN, based on a newly developed and validated prediction rule, and explains links to selecting a screening test. In pilot testing, personalized messages including ACN risk increased patients’ intent to be screened and influenced their test choice. Out of 57 patients who saw an estimate of their risk of current ACN, all 57 (100 percent) agreed or strongly agreed that “The information is important to me,” and 55 (95 percent) agreed or strongly agreed that “I would recommend this information to other people.” Providers also support using this information in making screening decisions.
Working with our partner healthcare systems, we have piloted a system that can deliver decision aids to patients effectively and affordably, through the patient portal of an electronic health record. The main objective of this application is to test whether providing patients and their providers with personalized messages about ACN risk results in higher screening uptake and higher decision quality, compared to an approach that does not utilize ACN risk. All participants in the study will be due for colorectal cancer screening and will have average risk, and all will view a decision aid that provides information about colorectal cancer screening. Half will also see information about their ACN risk. Half of these patients’ providers will receive a notification about their patient’s ACN risk. Our study will identify the impact on how many patients get screened within six months and whether they make an informed choice. We will collect information to guide implementation of the system that uses the electronic health record to deliver decision aids to patients and notifications to providers. Leadership, providers, and staff at our partner healthcare systems will work with our team to design and implement the study.
Patient consultants have worked with our team on developing this study and will be integrally involved in carrying it out. Local, regional, and national partners from organizations that work on cancer and screening have been involved in designing the study and will be involved in carrying it out and disseminating and implementing the results.
Shared Decision Making