Impact of Risk Assessment and Tailored versus Nontailored Risk Information on Colorectal Cancer Testing in Primary Care: A Randomized Controlled Trial.
BACKGROUND
Colorectal cancer screening is effective but underused. Guidelines for which tests are recommended and at what intervals depend on specific risks. We developed a tablet-based Cancer Risk Intake System (CRIS) that asks questions about risk prior to appointments and generates tailored printouts for patients and physicians summarizing and matching risk factors with guideline-based recommendations.


METHODS
Randomized controlled trial among patients who: (i) used CRIS and they and their physicians received tailored printouts; (ii) used CRIS to answer questions but received standard information about cancer screening while their physicians received a standard electronic chart prompt indicating they were age-eligible but not currently adherent for colorectal cancer screening; or (iii) comprised a no-contact group that neither used CRIS nor received any information while their physicians received the standard prompt. Participation in testing was assessed via electronic medical record at 12 months.


RESULTS
Participation in any colorectal cancer testing was three times higher for those who used the CRIS and received any printed materials, compared with no-contact controls (47% vs. 16%; P < 0.0001). Among CRIS users ages 50 and older, participation in any testing was higher in the tailored group (53% vs. 44%, P = 0.023).


CONCLUSIONS
Use of CRIS and receipt of any information facilitated participation in testing. There was more testing participation in the CRIS-tailored than nontailored group.


CONCLUSIONS
Asking patients questions about their specific risk factors and giving them and their providers information just prior to an appointment may increase participation in colorectal cancer testing. Tailoring the information has some added benefit.
Simmons Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas. Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas. celette.skinner@utsouthwestern.edu.
Celette Sugg
CS
Skinner
Simmons Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas. Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas. Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Ethan A
EA
Halm
Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
Wendy Pechero
WP
Bishop
Simmons Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas. Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
Chul
C
Ahn
Veterans Affairs San Diego Healthcare System, Division of Gastroenterology, Department of Internal Medicine, and the Moores Cancer Center, University of California San Diego, San Diego, California.
Samir
S
Gupta
People Designs, Durham, North Carolina.
David
D
Farrell
Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Jay
J
Morrow
Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Manjula
M
Julka
Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
Katharine
K
McCallister
Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
Joanne M
JM
Sanders
Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
Emily
E
Marks
Indiana University School of Nursing and Simon Cancer Center, Indianapolis, Indiana.
Susan M
SM
Rawl
D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity; D009780:Occult Blood; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology