Facilitating Risk-Appropriate Colorectal Cancer Testing

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DESCRIPTION (provided by applicant): Risk-appropriate testing can prevent a significant proportion of colon cancer deaths, but participation in such testing is too low. Patient factors (limited knowledge about need and benefits) and physician factors (sub- optimal recommendations) contribute to this problem. Because physician recommendation is the most important predictor of participation in testing, primary-care doctors are relied upon for the complicated task of determining risk-appropriate testing modalities and schedules. However, personal and familial risk factors that determine which test(s) and schedules are risk-appropriate for a given patient are not routinely summarized in primary-care records and can be time-consuming to collect and evaluate during a visit. Without help from a computerized intervention to collect and analyze personal and familial risk information, it is unlikely that a busy physician will make a risk-appropriate testing recommendation for every patient. We will test an easy-to-use touch-screen computer program used prior to primary-care appointments. The program, based on the Information-Motivation-Behavioral skills model, collects and evaluates risk data and provides patient-tailored recommendations for risk-appropriate testing. A pilot version we developed and pilot tested in primary-care settings showed feasibly for gathering and synthesizing information necessary to determine risk-appropriate tests and facilitate patient-physician discussion about colon cancer testing as well as ways the program should be adapted to maximize clinical utility. After adapting the program, we will conduct a clinic-based randomized trial in 3 Duke General Internal Medicine practice sites in which approximately 30,000 patients are seen by 28 MDs. Enrolled patients will be assigned to intervention or comparison group according to their physician. We will determine extent to which the program facilitates: 1) patient participation in risk-appropriate colorectal cancer testing, documented by electronic medical record (EMR) audit; 2) patient receipt of risk-appropriate physician recommendation for testing, documented by EMR audit; and 3) changes in patients' intent and perceived barriers to participating in risk-appropriate testing, documented by patient report. By providing an individually tailored intervention in conjunction with the primary-care visit, the program can be a helpful and non-obstructive adjunct to clinical care. If found effective, it should be highly disseminable, with great potential for improving colorectal cancer outcomes in the population at large.