Colorectal cancer screening doubled with use of a digital health program
Compared with usual care, more mPATH-CRC participants stated a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered.
Use of the Mobile Patient Technology for Health–CRC (mPATH-CRC) digital health program doubles the proportion of patients who completed colorectal cancer (CRC) screening, primarily because of patients' ability to self-order tests, according to a study published in the Annals of Internal Medicine.
David P. Miller Jr, MD, MS, from the Wake Forest School of Medicine, Department of Internal Medicine, in Winston-Salem, NC, and colleagues conducted a parallel-design, randomized controlled trial to determine the effect of mPATH-CRC on receipt of screening within 24 weeks. Participants were enrolled between June 2014 and May 2016 and were assigned with equal probability to usual care or mPATH-CRC. Follow-up was completed in October 2016.
Participants who interacted with mPATH-CRC viewed an 8.6-minute decision aid about CRC screening that had been previously validated and reviewed the 2 most commonly used tests, fecal testing for blood and colonoscopy. The mPATH-CRC program then let patients select their own screening test. The control program included a 4.3-minute video about diet and exercise produced by the Centers for Disease Control and Prevention. Control participants were not given the option to self-order screening tests or receive follow-up electronic messages.
The primary outcome was chart-verified completion of a CRC screening test within 24 weeks of enrollment. Secondary outcomes were assessed for all participants and included patients' ability to state a screening preference and intention to receive screening as measured on the postprogram iPad survey.
Research assistants screened 1183 patients to identify 640 eligible persons, of whom 450 enrolled. Approximately half (n = 223) were randomly assigned to mPATH-CRC and about half (n = 227) to the control program. All participants completed the assigned iPad programs, including the embedded surveys. Almost all participants completed the 24-week follow-up survey (86% [192 of 223] for mPATH-CRC and 90% [204 of 227] for control).
Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression OR, 2.5). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) “self-ordered” a test via the program.
“In this randomized controlled trial, the mPATH-CRC digital health program doubled the proportion of patients who completed CRC screening, primarily because of an increase in test orders,” the authors stated. “Two components of mPATH-CRC directly encourage screening orders: the decision aid, which increases patients' intention to receive screening, and the ability to self-order tests, which decreases barriers to order entry.”
Miller DP Jr., Denizard-Thompson N, Weaver KE, et al. Effect of a digital health intervention on receipt of colorectal cancer screening in vulnerable patients: a randomized controlled trial. Ann Intern Med. 2018 Mar 13. doi: 10.7326/M17-2315. [Epub ahead of print]