Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is putting a shared decision making approach into practice at clinics, hospitals, and community centers that uses a decision aid shown to help people chose a colorectal cancer screening approach.

Colorectal cancer, or CRC, is the third most common cause of cancer death in the United States. Regular screening is recommended for adults ages 45 and older to detect CRC early and reduce death. One way to screen for CRC is with a colonoscopy at a clinic or hospital. With this test, a doctor inserts a long, flexible tube with a camera into the colon to check for signs of CRC. Another way to screen is an at-home test that checks the stool for signs of CRC.

What is the goal of this implementation project?

In shared decision making, or SDM, patients and clinicians, like doctors or nurses, work together to make health decisions. Decision aids support SDM by helping people choose between two or more healthcare options based on what is most important to them. A PCORI-funded research study found that people who viewed a decision aid that used numbers to describe the risks and benefits of CRC screening were more informed and less conflicted about their decision to get screening.

This project is making the decision aid part of routine care at two health systems to help patients make informed decisions about CRC screening.

What will this project do?

The project team is working with two health systems in Indiana. One system has more than 60 primary care clinics in urban, suburban, and rural areas in Indiana. The other system includes a hospital and 12 community health centers that serve patients with low incomes.

The project is building on processes that both systems have in place to identify patients who are eligible for CRC screening and contact them before a visit. These processes use electronic health record, or EHR, systems or patient registries.

Patients who are eligible for screening can view the video-based decision aid by clicking on a link sent by text, email, or patient portal message. Patients and their clinicians discuss screening and which screening approach would work best for each patient.

To put the decision aid in place, the project team is:

  • Updating the decision aid to align with new CRC screening guidelines and translating it into Spanish
  • Working with IT staff to enable patients to access the decision aid through the patient portal so they can review it before their upcoming visit
  • Training staff and clinicians during regular meetings on how to use the decision aid to support SDM for CRC screening
  • Working with health system leaders and champions at each clinic who are encouraging and supporting clinicians and clinic staff in using the decision aid
  • Providing sites with the help of a practice facilitator to support ongoing use of the decision aid, including monthly phone calls and reports on the number of patients receiving the decision aid

The project team is also creating a guide on how to use the decision aid in different settings.

What is the expected impact of this project?

The project is demonstrating what’s required to make the decision aid part of routine care. At least 11,000 patients and more than 1,200 clinic staff and clinicians will use the decision aid. The project evaluation will confirm that the decision aid is working as intended to help patients make informed decisions about CRC screening.

More about this implementation project:

Stakeholders Involved in This Project

Current or past leaders from the following groups, which support shared decision making and CRC screening, are advising the project:

  • American Cancer Society
  • American Gastroenterological Association
  • National Colorectal Cancer Roundtable
  • Multi-Society Task Force on Colorectal Cancer Screening
  • National Cancer Institute

Implementation Strategies

  • Promote SDM.
  • Adapt the decision aid by updating it to reflect new guidelines and translating the decision aid into Spanish.
  • Adapt the program to work with sites’ existing resources, including providing different ways for patients to access the decision aid.
  • Adapt the EHR system to support delivery of the decision aid.
  • Provide educational materials to patients as part of the video-based decision aid.
  • Train healthcare system staff and clinicians on SDM, how to use the decision aid, and their role in CRC screening.
  • Use a phased implementation approach, launching the program in multiple waves based on location.
  • Provide sites with quarterly feedback reports.
  • Identify and prepare clinic champions, including clinic nurse managers and medical assistants experienced with SDM and CRC screening.
  • Provide technical assistance, including practice facilitation phone calls with site champions each month.
  • Develop an implementation playbook to support further use of the SDM approach at other sites.

Evaluation Outcomes

To document implementation:

  • Number of decision aids sent and accessed
  • Quality of SDM discussion using the CollaboRATE scale
  • Patient uncertainty about decision
  • Patient knowledge of CRC screening
  • Number of clinics adopting use of the decision aid
  • Fidelity to the components of the SDM program
  • Maintenance

To assess healthcare and health outcomes:

  • Uptake of CRC screening
  • Choice of screening test

Project Information

Peter Schwartz, M.D., Ph.D.
Teresa Damush, Ph.D.
Trustees of Indiana University
Large-Scale Implementation of a Decision Aid about Colorectal Cancer Screening

Key Dates

36 months
March 2023

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Using Numbers in a Decision Aid to Describe Risks and Benefits of Colorectal Cancer Screening Options


State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: October 18, 2023