A randomized controlled trial investigating the effect of providing personalized risk information to patients and their providers about the patient’s risk for advanced colorectal neoplasia has found no difference in screening uptake with either the personalized risk messages or provider notifications. However, the personalized risk messages did increase uptake of stool testing in one health-care system. The study by Schwartz et al was published in Annals of Internal Medicine.
Study Methodology
The researchers analyzed data from 214 providers and 1,084 patients at average risk for colorectal cancer across 41 primary care clinics in two health-care systems in the Midwest between November 2020 and May 2023. Eligible patients were aged 50 to 75 years who were scheduled to see a provider within a month and were due for a colorectal cancer screening.
Study participants were randomly assigned to view a colorectal screening decision aid with or without a personalized message (personalized decision aid or generic decision aid, respectively) about their advanced colorectal neoplasia risk. Providers were randomly assigned to receive notifications that their patient was due for screening, with or without a personalized message about the patient’s advanced colorectal neoplasia risk (personalized notification or generic notification, respectively).
The primary outcome was completion of any screening test within 6 months of enrollment. Secondary outcomes were completion of each specific screening test—including colonoscopy, stool test, and other approved screening tests—within 6 months. Logistic regression was used to estimate intervention effects.
Results
The researchers found that overall, there were no differences in screening uptake or test completion for the provider notification (predicted probabilities = 41.5% vs 36.4% for personalized vs generic; difference = 5.1 [95% confidence interval (CI) = –1.6 to 11.8] percentage points) or decision aid (predicted probabilities = 36.8% vs 41.0% for personalized vs generic; difference = –4.1 [95% CI = –10.2 to 1.9] percentage points) interventions.
Health system was an effect moderator for stool testing. For one health-care system, the stool testing rate was higher for personalized vs generic provider notification (predicted probabilities = 21.1% vs 7.9%; difference = 13.2 [95% CI = 1.6–24.8] percentage points) when the decision aid was generic.
The stool testing rate was higher for the personalized vs the generic decision aid (predicted probabilities = 21.4% vs 7.9%; difference = 13.5 [95% CI = 2.4–24.5] percentage points) when the provider notification was generic.
“Although including personalized risk for ACN [advanced colorectal neoplasia] in a decision aid or provider notification had no overall effect, it increased uptake of stool testing in one health system. …These findings require confirmation and extension in subsequent studies with potential to improve the uptake, effectiveness, and efficiency of colorectal cancer screening,” concluded the study authors.
Peter H. Schwartz, MD, PhD, lead author of this study and Director of the Indiana University Center for Bioethics at Indiana University School of Medicine, is the corresponding author of this study.
Disclosure: Funding for this study was provided by the Patient-Centered Outcomes Research Institute. For the study authors’ conflict-of-interest disclosures, visit www.acpjournals.org/journal/aim.
