Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients

Abstract

Background Screening for colorectal cancer (CRC) reduces mortality, yet over one-third of age-eligible Americans are unscreened. Objective To examine the effect of a digital health intervention (mPATH-CRC) on rates of CRC screening. Design Randomized clinical trial. Setting Six community-based primary care practices. Participants 450 patients (223 mPATH-CRC, 227 usual care) scheduled for a primary care visit and due for routine CRC screening. Intervention An iPad app that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients. Measurements Chart-verified completion of CRC screening within 24 weeks (primary outcome); ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests (secondary outcomes). All outcome assessors were blinded to randomization arm. Results Baseline characteristics were similar between groups and included 37% with limited health literacy and 53% with annual incomes < $20,000. CRC screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression OR 2.5, 95% CI 1.6 – 4.0). Compared to usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) “self-ordered” a test via the program. Limitations Study was conducted among English-speaking individuals within a single healthcare system. Conclusions A digital health intervention that allows patients to “self-order” tests can increase receipt of CRC screening. Future research should identify methods for implementing similar interventions into clinical care. Trial registration ClinicalTrials.gov (NCT02088333) Primary Funding Source National Cancer Institute

Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

“…A study examining the impact of combining a decision aid with patient navigation in a diverse, vulnerable patient population did demonstrate a strong impact on screening completion but was unable to separate the effects of the decision aid from patient navigation . A recent study incorporating an iPad‐based CRC decision aid with test‐ordering capability into the office visit demonstrated a doubling of CRC screening completion from 15% to 30% among vulnerable primary care patients who were randomized to the intervention …”

“…179 A recent study incorporating an iPad-based CRC decision aid with test-ordering capability into the office visit demonstrated a doubling of CRC screening completion from 15% to 30% among vulnerable primary care patients who were randomized to the intervention. 180 Nonoffice-based strategies, including "outreach" strategies whereby patients receive invitations to screening via mail, have shown a 5% to 15% increase in adherence rates. Mailed reminders with or without FIT kits/gFOBT cards timed to a scheduled clinic appointment can increase screening.…”

How effective are digital interventions in increasing flu vaccination amongst pregnant women? A systematic review protocol

“…To date, no review has examined the effectiveness of digital interventions in increasing flu vaccination uptake amongst pregnant women. A recent review has examined interventions that have been used to increase flu vaccination uptake, but current advancements in technology and internet use, and previous demonstrated effectiveness of digital health interventions (22,10,11,12), it is relevant and timely to examine digital flu vaccination interventions.…”

From guideline to practice: New shared decision‐making tools for colorectal cancer screening from the American Cancer Society

“…A recent randomized trial conducted in community health center practices showed higher rates of CRC screening for patients who received a decision aid and support from a navigator compared with patients who received usual care . Another randomized trial conducted in community‐based primary care settings that serve many low health literacy and low‐income patients showed higher CRC screening rates among patients who received a digital health intervention, including a patient decision aid and self‐referral feature, compared with patients who received usual care …”

“…10 Another randomized trial conducted in community-based primary care settings that serve many low health literacy and lowincome patients showed higher CRC screening rates among patients who received a digital health intervention, including a patient decision aid and self-referral feature, compared with patients who received usual care. 11 Second, how should the tools be used? We chose to develop decision support interventions that can be used to encourage deliberation between patients and health care providers during the clinical encounter when CRC screening is discussed and tests are ordered.…”