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

 描述（由申请人提供）：结直肠癌（CRC）是美国第三大常见癌症，每年有超过50，000人死于该疾病。尽管有多种有效的筛查测试，但相对于其他癌症筛查，CRC筛查仍然未得到充分利用。在投保人群中这种利用不足背后的一个驱动因素是医生建议的护理和患者接受筛查之间存在的差距。如何最好地支持患者在CRC筛查，一旦他们有一个医生的护理建议仍然未知。拟议项目将测试访视后患者门户工具e-Assist的有效性和影响，以参与和支持初级保健患者做出关于CRC筛查的决策并最终获得CRC筛查。该工具有目的地利用了医生护理建议提供的行动提示以及现在在初级保健实践中常见的安全患者门户平台。它将重要的患者-医生决策内容与帮助消除筛查的个人和结构性障碍无缝结合起来。我们的研究将回答四个首要问题：（1）访视后，患者门户工具，电子辅助，可以增加医生推荐的CRC筛查的依从性？(2)e-Assist如何让初级保健患者参与CRC筛查决策过程？(3)是否有初级保健人群的亚组，对他们来说，e-Assist更具吸引力和有效性？以及（4）需要对电子协助进行哪些调整，以提高其覆盖范围，并确保其采用、实施，以及最终对不同初级保健患者和诊所中循证CRC筛查使用的影响？这些问题将通过一项两组、实用的随机试验来解决，并辅以焦点小组的调查结果以及对患者、临床医生和其他诊所工作人员的深入访谈 确保不仅全面了解计划的有效性和实施情况，而且全面了解推动整个计划影响的因素。结果将说明电子工具如何 可在门诊就诊后使用，以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.