Nearly 40% of age-eligible U.S. adults are non-adherent to colorectal cancer screening (CRCS) recommendations and interventions to increase adherence can be less than optimally effective (fecal occult blood test kit mailings) or expensive (patient navigators). Few interventions take patient CRCS preference into accountant, to our knowledge; interventions have not systematically addressed test-specific patient-reported barriers. As the nation moves to the use of electronic health records, patient-centered health information technology systems (e.g., integrated personal health records), have great potential to improve quality of care by providing: centralized medical information, patient education and activation, enhanced patient and clinician communication, decision support, and reminder systems. Developing an effective, interactive tool that engages adults in making a CRCS decision is significant from a public health perspective as e-health has the ability to reach a large number of people at relatively little cost. We propose to combine screening and barriers information with preference elicitation strategies to create MyCRCS+, a novel, web-based, tailored decision aid tool embedded within personal health record systems to promote informed decisions and increase CRCS. This 5-year study involves 3 phases. Phase I consists of formative work to create the theory-based MyCRCS+ intervention, which will be integrated into an existing interactive preventive health record (IPHR). In short, MyCRCS+ will engage non-adherent patients (50-75 years) to assess their CRCS test preferences and corresponding test-specific barriers in real time. Based on patient characteristics and data from the electronic medical record, tailored messages/video will appear in pop-up screens to reduce confusion and address their top 5 reported test-specific barriers while incorporating motivational strategies and an action plan. In Phase II we will conduct a 3-arm efficacy randomized trial (n=510; 170 people/arm) of two different versions of MyCRCS+ (one assessing and addressing Test Preferences only; the other assessing and addressing both Test Preferences and Test-specific Barriers) vs. standard IPHR-CRCS (usual care is web-based and provides basic information on CRCS and links to third-party web sites) with assessment at baseline, 3-months, and 12- months. In Phase III we will conduct a feasibility study of the most efficacious MyCRCS+ arm from Phase II in four primary care practices. We have effectively conducted research relevant to this application in various settings using similar designs, methods, and timelines to those proposed here.
Nearly 40% of U.S. adults, ages 50 and older, are non-adherent to colorectal cancer screening (CRCS) recommendations and interventions to increase adherence are less than optimally effective. Few interventions take patient CRCS preference into account and, to our knowledge; interventions have not systematically addressed test-specific patient-reported barriers. Patient-centered health information technology systems have great potential for patient education and activation, enhanced patient and clinician communication, decision support, and reminder systems. A web-based CRCS decision tool embedded within the personal health record addressing patient CRCS preferences and test-specific barriers offers a cost- effective approach to reach many non-adherent people.
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