This proposal aims to improve colorectal cancer (CRC) screening uptake by developing and validating a novel online decision aid called the Automated Colorectal Cancer Educational Support System (ACCESS). While CRC is preventable, it still remains a major public health issue, as it is the third most prevalent and deadly malignancy in the U.S. The U.S. Preventive Services Task Force (USPSTF) recommends that all Americans at average risk for CRC undergo screening starting at age 50, yet one-third of Americans are unscreened. Eliciting patient preferences by engaging in shared decision making via decision aids has been proposed as a potentially effective strategy to improve screening rates. CRC screening is ideally suited for a shared decision making approach, as the USPSTF endorses 7 different testing options (e.g., stool-, imaging-, and endoscopy-based tests), each with distinct advantages and disadvantages. Of the few existing CRC screening decision tools, most were ineffective as they were beset by imprecise assessment of patients? preferences and ineffective integration in clinical workflows. This proposal will address these gaps by creating an online, efficient, conjoint analysis- based decision aid called ACCESS that generates a personalized report that rank orders the importance of each test attribute (e.g., accuracy, invasiveness, etc.) in patients? decision making. The report will also be shared with their clinicians via the electronic health record so that they can efficiently recognize their patients? priorities when selecting a screening test. The hypothesis is that use of ACCESS, through optimizing shared decision making, will lead to selection of a modality that accurately matches each patient?s unique values, and as a result, increase screening uptake. To test this hypothesis, the proposal will achieve the following aims: (1) Gain insights into patients? knowledge, attitudes, beliefs, and drivers of decision making when selecting among the different screening options through conjoint analysis, a quantitative technique that assesses how individuals make tradeoffs; (2) Build the ACCESS decision aid in partnership with patients, clinicians, implementation and behavioral science experts, and computer scientists; (3) Conduct a pilot randomized controlled trial to determine if ACCESS improves CRC screening uptake vs. usual care. To successfully complete the project, the PI will receive mentorship from experienced clinicians, health services researchers, implementation and behavioral scientists, and digital health experts. The PI will also address his knowledge gaps by taking formal coursework in implementation and behavioral sciences, conjoint choice modeling, qualitative analysis, quality measurement and improvement, and trial design. He will also participate in R grant writing workshops over the award period. Obtaining these competencies combined with successful completion of the study will allow him to work towards his goal of becoming an independent, NIH-funded digital health scientist focused on enhancing cancer prevention and health promotion through the user-centered development and use of innovative, scalable, evidence-based technologies that support patients and clinicians in making shared decisions.
Colorectal cancer (CRC) remains a major public health issue, as one-third of Americans are unscreened; this study aims to improve CRC screening uptake by developing and validating the Automated Colorectal Cancer Educational Support System (ACCESS) ? an online, immersive, and interactive conjoint analysis-based decision aid that supports patients in selecting a CRC screening modality congruent with their preferences and values. Development of ACCESS will: (1) be informed by foundational research using qualitative research and conjoint analysis methodologies that will gain insights into patients? knowledge, attitudes, beliefs, and drivers of decision making regarding the different CRC screening test options; and (2) be built in partnership with patients, clinicians, implementation scientists, user interface and experience experts, and computer scientists. It will be validated through a pilot randomized controlled trial that tests whether provision of the ACCESS decision tool, through optimizing shared decision making and improving the patient-clinician interaction, leads to selection of a screening modality that accurately maps to a patient?s values, and as a result, increases acceptance and completion of CRC screening.
