Promoting Veteran-Centered Colorectal Cancer Screening
| Status: | Completed |
|---|---|
| Conditions: | Colorectal Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 70 - 75 |
| Updated: | 12/5/2018 |
| Start Date: | November 20, 2015 |
| End Date: | August 8, 2018 |
Systematic efforts to improve colorectal cancer screening use in the VA Healthcare System
have resulted in an increase in not only appropriate, but also inappropriate use of
screening. The purpose of this study is to test a new, more patient-centered approach to
colon cancer screening. In older individuals (ages 70 to 75) who are "due" for screening, the
investigators will provide education on the benefits and harms of colon cancer screening. But
instead of simply providing these patients with "average" information about these benefits,
the investigators will give them information that takes into account their personal
characteristics (e.g., age, gender), overall health, and screening history and therefore
applies to them more personally. The investigators will also work with the health system to
create time and space for patient and doctor to discuss whether screening is the right choice
for each individual. This way, patients can make an informed choice about what is right for
them, with the help of their doctor. In the future, the results of this study will help
patients make more informed screening decisions, especially when the benefits of screening
may be uncertain for them personally.
have resulted in an increase in not only appropriate, but also inappropriate use of
screening. The purpose of this study is to test a new, more patient-centered approach to
colon cancer screening. In older individuals (ages 70 to 75) who are "due" for screening, the
investigators will provide education on the benefits and harms of colon cancer screening. But
instead of simply providing these patients with "average" information about these benefits,
the investigators will give them information that takes into account their personal
characteristics (e.g., age, gender), overall health, and screening history and therefore
applies to them more personally. The investigators will also work with the health system to
create time and space for patient and doctor to discuss whether screening is the right choice
for each individual. This way, patients can make an informed choice about what is right for
them, with the help of their doctor. In the future, the results of this study will help
patients make more informed screening decisions, especially when the benefits of screening
may be uncertain for them personally.
Colorectal cancer (CRC) screening is a widely recommended, evidence-based preventive service
that has traditionally been underused. Over the last decade, organized efforts by the
Veterans Health Administration (VHA) to increase population screening among Veterans have
been successful. But these population-centered efforts have increased screening utilization
in a way that is not always concordant with screening benefit, particularly among older
Veterans, those with comorbid illness, and those who have previously been screened. As
patients get older, acquire health problems, and undergo negative screening tests, the
benefit of screening decreases and the potential harm of screening increases. Yet, existing
population-centered efforts fail to adequately inform these patients about this changing
balance in benefit and harm, often yielding screening utilization that is discordant with
benefit. The purpose of this study is to test a more Veteran-centered approach to screening
in these individuals, one that encourages informed, personalized screening decisions based on
individual values, preferences, and health status.
The 3-part intervention consists of: (1) a decision aid to help Veterans make informed
screening decisions; (2) education for providers on how the benefits of screening vary
between patients; and (3) modification of clinical reminder systems to allow Veterans to make
informed decisions about screening. The intervention will be tested in a pragmatic
cluster-randomized controlled trial (cluster = provider) at two sites in the VA Ann Arbor
Healthcare System. The primary outcome will be whether screening was ordered at the clinic
visit. The investigators will also assess the appropriateness of screening orders (i.e.,
whether screening is ordered in concordance with screening benefit), conceptual understanding
of screening, elements of informed decision-making addressed in the screening discussion, and
screening utilization at 6 months.
that has traditionally been underused. Over the last decade, organized efforts by the
Veterans Health Administration (VHA) to increase population screening among Veterans have
been successful. But these population-centered efforts have increased screening utilization
in a way that is not always concordant with screening benefit, particularly among older
Veterans, those with comorbid illness, and those who have previously been screened. As
patients get older, acquire health problems, and undergo negative screening tests, the
benefit of screening decreases and the potential harm of screening increases. Yet, existing
population-centered efforts fail to adequately inform these patients about this changing
balance in benefit and harm, often yielding screening utilization that is discordant with
benefit. The purpose of this study is to test a more Veteran-centered approach to screening
in these individuals, one that encourages informed, personalized screening decisions based on
individual values, preferences, and health status.
The 3-part intervention consists of: (1) a decision aid to help Veterans make informed
screening decisions; (2) education for providers on how the benefits of screening vary
between patients; and (3) modification of clinical reminder systems to allow Veterans to make
informed decisions about screening. The intervention will be tested in a pragmatic
cluster-randomized controlled trial (cluster = provider) at two sites in the VA Ann Arbor
Healthcare System. The primary outcome will be whether screening was ordered at the clinic
visit. The investigators will also assess the appropriateness of screening orders (i.e.,
whether screening is ordered in concordance with screening benefit), conceptual understanding
of screening, elements of informed decision-making addressed in the screening discussion, and
screening utilization at 6 months.
Inclusion Criteria:
- Aged 70-75 years
- Due for screening according to the 2008 USPSTF colorectal cancer screening guideline
- Scheduled for a non-urgent primary care visit at the Ann Arbor VA Medical Center or
Toledo VA Community-Based Outpatient Clinic
Exclusion Criteria:
- Increased risk for colorectal cancer (and therefore not candidates for average-risk
screening)
- Limited life expectancy (e.g., enrolled in hospice or diagnosed with metastatic
cancer), or for whom the provider previously documented an intention not to pursue
screening.
- Scheduled for an appointment where stimulating a discussion about screening is likely
to be inappropriate: urgent appointment (for acute complaints), follow-up visit after
hospitalization
- Have a condition that would impair his/her ability to participate in the study:
dementia or other cognitive impairment, visual impairment, non-English speaking
- Assigned to an ineligible primary care provider (i.e., the provider did not consent to
the study)
- Have Medical Guardian who makes decisions for the patient about his/her care
We found this trial at
1
site
Click here to add this to my saved trials
