Research Tests Decision Support Technology for Guiding Cancer Screening Choices

Christina Mattina

A new study indicates that a technology-based intervention could help patients make informed decisions about cancer screening.
 
The study, published in Annals of Family Medicine, tracked the outcomes from the implementation of a decision support module at 12 practices serving over 55,000 patients. The module was embedded in the online portals of 11,458 patients who faced an upcoming decision on breast, colorectal, or prostate cancer screening.
 
An initial assessment within the module gathered important information like patients’ concerns with cancer screening, desired levels of decision support, decision-making style, and optimal method of receiving information on the recommended screening options. Using this feedback, the module created a tailored page that provided the patient’s preferred amount of relevant information using either words, numbers, pictures, or stories.
 
Patients could then indicate whether they had made up their minds on their next steps, and if so, whether they wanted their physician to receive a summary of their decision preferences that included discussion points, patient questions, and the preferred balance of decision making between the patient and the provider. Questionnaires collected feedback on the module from the patient and the clinician after the office visit when the results were discussed.
 
Of the 11,458 patients invited to use the module, 2355 started it but only 903 completed it. Around a quarter of module users clicked on at least 1 educational resource, and patients accessed on average 3.5 resources each. Patients most commonly sought information on options for getting screened (70.8%), what screening test works best (49.8%), and potential complications from screening (45.7%).
 
Patients who forwarded the decision summary to their physicians were more likely to have screening discussed at their next visit, and 80.9% said the conversation helped reduce their fears or worries about screening. A majority of patients agreed that the module was easy to complete and understand, and sizable proportions reported that it had improved their knowledge before the office visit (48.1%) and got them more involved in the screening decision (47.7%). Finally, patients who had completed the module were significantly more likely to undergo screening within 3 months than those who had not started or completed it.
 
According to the researchers, these findings indicate that technology-enabled decision support initiatives are a feasible way to empower patients in decision making and help improve communication between patients and physicians. They noted that invitation response rates and module completion levels were relatively low, but could potentially increase with better workflow integration. This was also a self-selected sample without a control group, so future trials will need to be randomized and controlled in order to more fully evaluate the role of decision support technologies in cancer screening and other health choices.
 
The researchers acknowledged that implementing new technologies within practice workflows will not be an easy task, but if “future research confirms the benefits of this approach—more informed patients, better decisions, and wiser use of encounter time—the return on investment could offset the implementation costs and improve care.”
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