Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening

The e-assist: Colon Health study - A protocol study

Jennifer Elston Lafata, Yongyun Shin, Sue Flocke, Sarah T. Hawley, Resa M. Jones, Ken Resnicow, Michelle Schreiber, Deirdre A. Shires, Shin Ping Tu

Research output: Contribution to journalArticle

Abstract

Introduction How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening. Methods and analysis In partnership with healthcare teams, we developed 'e-assist: Colon Health', a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians. Ethics and dissemination All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action. Trial registration number NCT02798224; Pre-results.

Original languageEnglish (US)
Article numbere023986
JournalBMJ open
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Early Detection of Cancer
Colorectal Neoplasms
Colon
Physicians
Health
Electronic Health Records
Patient Care Team
Research Ethics Committees
Colonoscopy
Quality Improvement
Ethics
Cues
Logistic Models
Outcome Assessment (Health Care)
Delivery of Health Care

Keywords

  • colorectal cancer screening
  • decision support
  • electronic health record
  • patient portal
  • practice-embedded clinical trial
  • primary care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening : The e-assist: Colon Health study - A protocol study. / Lafata, Jennifer Elston; Shin, Yongyun; Flocke, Sue; Hawley, Sarah T.; Jones, Resa M.; Resnicow, Ken; Schreiber, Michelle; Shires, Deirdre A.; Tu, Shin Ping.

In: BMJ open, Vol. 9, No. 1, e023986, 01.01.2019.

Research output: Contribution to journalArticle

Lafata, Jennifer Elston ; Shin, Yongyun ; Flocke, Sue ; Hawley, Sarah T. ; Jones, Resa M. ; Resnicow, Ken ; Schreiber, Michelle ; Shires, Deirdre A. ; Tu, Shin Ping. / Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening : The e-assist: Colon Health study - A protocol study. In: BMJ open. 2019 ; Vol. 9, No. 1.
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