Study Finds Patients Using an iPad App to Self-Order Tests Doubled Colon Cancer Screening Rates

Key Points

  • Patients using an iPad app that informs them of the need for colorectal cancer screenings, helps them make a decision, and lets them self-order tests were twice as likely to undergo screening compared to patients in the usual care group—30% vs 15%, respectively.
  • A digital health intervention that allows patients to self-order tests can increase colorectal cancer screenings.
  • Future research should identify methods for implementing similar interventions in clinical care.

According to the American Cancer Society (ACS), colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States and the second leading cause of death from cancer. Projections by the ACS show that, this year, about 50,630 people will die from the disease. However, studies show a lower mortality rate among patients who undergo screening than among those who do not.

To examine the effect of using digital health interventions to increase colorectal cancer screening rates in a socioeconomically diverse patient population, researchers conducted a randomized clinical study using an iPad application that informs patients of the need for colorectal cancer screenings, helps them make a decision, and lets them self-order tests. The study found that patients using the app were twice as likely to undergo screening compared to patients in the usual care group—30% vs 15%, respectively. Future research should identify methods for implementing similar digital health interventions in clinical care. The study by Miller et al is published in Annals of Internal Medicine.

Study Methodology

The researchers developed a digital health intervention called Mobile Patient Technology for Health-CRC (mPATH-CRC), an iPad application that informs patients of the need for screening, helps them make a decision, lets patients self-order a test, and sends automated electronic messages to help patients complete the test. They then conducted a randomized clinical trial to determine the effect of mPATH-CRC in six community-based care practices affiliated with a large academic health system in North Carolina. All practices share a common electronic health record (EHR) that notifies providers if colorectal screening is due. They queried the EHR to identify English-speaking persons, ages 50 to 74, that were scheduled to see a primary care provider and were due for a colorectal cancer screening.

The researchers enrolled 450 patients—223 in the mPATH-CRC group and 227 in the usual care group. The patients in the mPATH-CRC group used the iPad app at their primary care provider’s office on a device owned by the practice and the patients received follow-up support on their own mobile device. The patients using the app were educated about different types of screening tests and could order the test they wanted.

Patients in both groups took a brief survey about colon cancer screening.

Study Findings

The researchers found that baseline characteristics were similar in both groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20,000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression OR, 2.5; 95% confidence interval = 1.6–4.0). Compared with 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.

“In summary, mPATH-CRC doubled the proportion of patients who completed CRC screening. Although screening increased substantially in this study that included many persons with low income and limited health literacy, approximately half of [the] patients did not complete their ordered tests. Incorporating more strategies to help patients complete their tests could further increase the effectiveness of mPATH-CRC. Future research should identify methods for implementing digital health interventions like mPATH-CRC into clinical care,” concluded the study authors.

Funding for this study was provided by the National Cancer Institute, Wake Forest Clinical and Translational Science Institute, and the Wake Forest Comprehensive Cancer Center.

David P. Miller, Jr. MD, MS, reports grants from the National Cancer Institute and the National Institutes of Health; Kathryn E. Weaver, PhD, MPH, and Jennifer L. Troyer, PhD, report grants from the National Institutes of Health. The remaining study authors reported no conflicts of interest. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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