Impact of Family History and Decision Support on High-risk Cancer Screening

Eligible patients are aged 40-65 years, enrolled in primary care, do not have a personal
history of colorectal cancer, and have some knowledge of family health history. In Aim 1, a
retrospective chart review will be conducted to determine the baseline rate of documenting
family health history of colorectal cancer in the medical record for patients enrolled in the
Aim 2 randomized trial. In Aim 2, consented patients will be randomized to provide
patient-entered family health history and receive patient and provider decision support at
enrollment or 12 months later (wait-list control). The primary outcome is risk-appropriate
CRC screening/surveillance referral for patients 12 months post-enrollment. Secondary
outcomes include patient uptake of recommendations and referral for genetic consultation 12
months post-enrollment. In Aim 3, qualitative interviews will be conducted with physicians
and clinic leaders; data will be analyzed using conventional content analysis. In Aim 4, data
will be obtained from the administrative databases and patient medical records to conduct a
budget impact analysis.

Inclusion Criteria:

Primary care provider inclusion criteria:

- primary care physician,

- physician assistant, or nurse practitioner;

- at least one half-day of primary care clinic per week.

Patient inclusion criteria:

- assigned to an enrolled PCP;

- English as preferred language;

- no plans to relocate or leave the VA system in the next 12 months;

- at least one primary care appointment in the 18 months prior to enrollment;

- upcoming PCP appointment with assigned PCP;

- aged 40-64 years; no previous history of colorectal cancer or adenomatous polyps or
inflammatory bowel disease;

- no endoscopy within previous 3 years; some knowledge of family health history

Exclusion Criteria:

n/a (contained within inclusion criteria)