Trial of a Computer-Based Presentation of Quantitative Information About Colorectal Cancer Screening

Fifty thousand people die from colorectal cancer (CRC) every year, making it the second
leading cause of death from cancer in the United States. And although there are multiple
screening tests that reduce the morbidity and mortality of this disease, less than 60% of
eligible individuals are up to date with recommended screening.

One of the challenges to improving screening is helping patients understand the range of
approved tests, including colonoscopy, sigmoidoscopy, and stool testing (such as fecal
immunochemical testing (FIT)). Patients rarely consider all their options, partly due to
the limited time they have to learn about them during busy doctor's visits.

Computer-based presentations, including decision aids, are a promising tool for improving
patient understanding in this and other areas, by giving patients significant amounts of
information.

But there are important questions about how to design such presentations, including whether
they should provide quantitative data about the risks and benefits of screening. Some
experts feel that these numbers and graphs are necessary for fully informed decision-making,
while others are concerned that they may confuse patients or dissuade them from screening.

The investigators have created and pilot tested a computer-based presentation of
quantitative information about CRC screening. The investigators found that subjects who
viewed the program in a non-healthcare setting exhibited significantly increased interest in
screening. In addition, the investigators tested a version of the program that includes a
"nudge" towards stool testing with FIT, as a way of encouraging individuals who are confused
to undergo some form of screening. In our testing, receiving the nudge was associated with
a significant increase in interest in FIT.

The investigators now seek to conduct a randomized, controlled study of our computer-based
presentation with Clarian patients who are due for CRC screening. All subjects will first
view a general video about CRC screening and then will be randomly placed into four groups
(using a 2x2 design), to receive quantitative information (or not), and a nudge towards FIT
(or not).

The results will determine whether a presentation of quantitative information can increase
patient understanding, quality of decision-making, and uptake of CRC screening. The results
will serve as pilot data for a larger, externally funded study of the effect of
individualized ("personalized") quantitative information in this area