Abstract
BackgroundColorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3–10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices.MethodsIn this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers’ experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective.DiscussionThis trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs.Trial registrationClinicalTrials.gov, NCT02247336. Registered on 25 September 2014.
Highlights
Colorectal cancer is the fourth most commonly diagnosed cancer in the United States
3–10% of the United States population [17] is thought to be at increased risk for Colorectal cancer (CRC) and, meets criteria for more intensive screening and management, < 50% receive this recommended care [18,19,20]
This study focuses on CRC as the disease context for the primary outcome, we ask patients to enter their personal and family health history (FHH) for all diseases included in MeTree
Summary
3–10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices. Different screening modalities and/or frequencies are recommended for patients above population-level risk (hereafter referred to as increased risk), such as those with a personal or family history of colorectal neoplasia or adenomatous polyps [8]. 3–10% of the United States population [17] is thought to be at increased risk for CRC and, meets criteria for more intensive screening and management, < 50% receive this recommended care [18,19,20]
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