e-Assist: A Post-Visit Patient Portal Tool to Promote Colorectal Cancer Screening

 描述(申请人提供)：结直肠癌(CRC)是美国第三常见的癌症，每年有超过50,000人死于这种疾病。尽管有多种有效的筛查试验，但与其他癌症筛查相比，结直肠癌筛查仍未得到充分利用。在参保人群中这种利用不足背后的一个驱动因素是医生建议护理和患者接受筛查之间存在的差距。一旦患者得到医生的建议进行治疗，如何最好地在结直肠癌筛查中提供支持仍是未知的。拟议的项目将测试走访后患者门户工具e-Assisted的有效性和影响，该工具用于让初级保健患者参与并支持他们关于结直肠癌筛查的决策，并最终在他们获得筛查时提供支持。该工具有意利用医生提供的护理建议提供的行动提示，以及现在初级保健实践中常见的安全患者门户平台。它无缝地将重要的患者-医生决策内容与帮助消除筛查的个人和结构性障碍结合在一起。我们的研究将回答四个主要问题：(1)就诊后患者门户工具e-Assistate能否增加医生建议的CRC筛查的依从性？(2)e-Assistate如何让初级保健患者参与CRC筛查决策过程？(3)初级保健人群中有哪些群体认为e-Assistate更具吸引力和有效性？以及(4)需要怎样的调整才能通过电子辅助来改善其覆盖范围，并确保其被采用、实施，并最终对不同初级保健患者和诊所中基于证据的CRC筛查使用产生影响？这些问题将通过一项双臂、实用的随机试验来解决，并辅之以焦点小组的发现和对患者、临床医生和其他诊所工作人员的深入采访。 确保不仅全面了解计划的有效性和实施情况，而且全面了解推动计划整体影响的因素。结果将说明电子工具是如何 可在办公室访问后用于支持患者决策，以及在初级保健中传播和实施循证癌症筛查服务。

 DESCRIPTION (provided by applicant): Colorectal rectal cancer (CRC) is the third most common cancer in the US with over 50,000 individuals dying annually from the disease. Despite multiple effective screening tests, CRC screening remains underutilized relative to other cancer screening. A driving factor behind this underutilization among insured populations is the gap that exists between a physician recommendation for care and the patient's receipt of screening. How best to support patients in CRC screening once they have a physician recommendation for care remains unknown. The proposed project will test the effectiveness and impact of a post-visit, patient portal tool, e-Assist, for engaging and supporting primary care patients in their decision making regarding, and ultimately in their obtaining, CRC screening. The tool purposely leverages the cue to action provided by a physician recommendation for care as well as the secure patient portal platform now commonly found within primary care practices. It seamlessly combines important patient-physician decision making content with assistance in removing personal and structural barriers to screening. Our research will answer four overarching questions: (1) Can a post-visit, patient portal tool, e-Assist, increase adherence to physician-recommended CRC screening? (2) How does e-Assist engage primary care patients in the CRC screening decision making process? (3) Are there subgroups of the primary care population for whom e-Assist is more engaging and effective? and (4) What adaptations are needed to e-Assist to improve its reach, and ensure its adoption, implementation, and ultimately its impact on evidence-based CRC screening use among diverse primary care patients and clinics? These questions will be addressed using a two-arm, practical randomized trial supplemented with findings from focus groups and in-depth interviews with patients, clinicians and other clinic staff to ensure a comprehensive understanding of not only program effectiveness and implementation, but the factors driving overall program impact. Results will illustrate how e-tools can be used following an office visit to support both patient decision making, and the dissemination and implementation of evidence-based cancer screening services in primary care.