An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

BackgroundColorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices.MethodsIn this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers' experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective.DiscussionThis trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs.Trial registrationClinicalTrials.gov, NCT02247336 . Registered on 25 September 2014

Text-message Reminders in Colorectal Cancer Screening (TRICCS): a randomised controlled trial

BACKGROUND: We investigated the effectiveness of a text-message reminder to improve uptake of the English Bowel Cancer Screening programme in London. METHODS: We performed a randomised controlled trial across 141 general practices in London. Eight thousand two hundred sixty-nine screening-eligible adults (aged 60-74 years) were randomised in a 1 : 1 ratio to receive either a text-message reminder (n=4134) or no text-message reminder (n=4135) if they had not returned their faecal occult blood test kit within 8 weeks of initial invitation. The primary outcome was the proportion of adults returning a test kit at the end of an 18-week screening episode (intention-to-treat analysis). A subgroup analysis was conducted for individuals receiving an invitation for the first time. RESULTS: Uptake was 39.9% in the control group and 40.5% in the intervention group. Uptake did not differ significantly between groups for the whole study population of older adults (adjusted odds ratio (OR) 1.03, 95% confidence interval (CI) 0.94-1.12; P=0.56) but did vary between the groups for first-time invitees (uptake was 34.9% in the control and 40.5% in the intervention; adjusted OR 1.29, 95% CI 1.04-1.58; P=0.02). CONCLUSIONS: Although text-message reminders did not significantly increase uptake of the overall population, the improvement among first-time invitees is encouraging.British Journal of Cancer advance online publication, 25 April 2017; doi:10.1038/bjc.2017.117 www.bjcancer.com

Improving Osteoporosis Screening Rates of Women in a Primary Care Setting

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used as a framework to guide the project for the 77 females at a small primary care clinic in northern Indiana. After organizational approval of this EBP project, letter reminders were created and mailed to those females who were 65 years and older and who did not have a reported DXA screen on their electronic medical record. To determine if the mailed reminder was effective, data was collected from the literature evidence pieces and then compared to the post-intervention group data. The data was analyzed using the binomial test in an effort to determine the effectiveness of the patient mailed reminder letter. Implications for practice to be discussed

Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care: A Feasibility Study

The value of using colorectal cancer screening (CRCS) as a preventative tool in the development of colorectal cancer (CRC) is well established; however, mobilizing patients to participate in one of the CRCS methods remains an issue. Research to engage patients more actively in CRCS has shown that health care providers have the most influence on patient participation. This dissertation first examines the various provider-directed interventions proven to increase CRCS in the primary care setting. Next, the detailed theoretical and methodological processes are examined based on the previous research from the first article. The PPRNet TRIP QI Model was chosen based on a clear and applicable theoretical framework with proven strategic interventions to increase CRCS in the primary care setting. Finally, the qualitative and quantitative results from implementation of the PPRNet TRIP QI Model in a rural, West Virginia primary care setting are analyzed, confirming feasibility of implementation and showing promising early indications of success to increase CRCS rates. The information presented within this dissertation creates the foundation for future studies of implementing the PPRNet TRIP QI Model to increase CRCS in rural, primary care settings

The LEAD trial. The effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: a randomised controlled trial

Objectives This trial tested the effectiveness of a self-administered web-based decision aid, targeted at citizens with lower educational attainment, on informed choice about colorectal cancer screening participation as assessed by group levels of knowledge, attitudes and uptake. Methods The randomised controlled trial was conducted among 2702 screening-naïve Danish citizens, 53–74 years old, with lower educational attainment. Baseline questionnaire respondents (62%) were allocated to intervention and control groups. Intervention group citizens received the decision aid. Outcomes were informed choice, worries and decisional conflict. Results Analyses were conducted among 339 eligible citizens. The mean difference in knowledge score change between intervention and control group was 0.00 (95% confidence interval (CI): -0.38;0.38). Trends towards more positive screening attitudes (mean difference in score change: 0.72, 95% CI: -0.38;1.81) and higher screening uptake (7.6%, 95% CI:−2.2;17.4%) were observed. Worries (−0.33, 95% CI: −0.97;0.32) and decisional conflict (mean difference: −3.5, 95%CI: −7.0;−0.1) were slightly reduced. Conclusions The decision aid did not affect informed choice or knowledge. However, there were trends towards increased screening uptake and more positive screening attitudes. Practice implications Being a simple intervention and easily administered, the decision aid could represent a cost-effective way of enhancing screening uptake, and some elements of informed decision-making

Qualitative analysis of 6961 free-text comments from the first National Cancer Patient Experience Survey in Scotland

Objectives To analyse free-text responses from the first Scottish Cancer Patient Experience Survey (SCPES) to understand patients’ experiences of care, identify valued aspects and areas for improvement.  Design Inductive thematic analysis of seven free-text comment boxes covering all stages of the cancer experience, from a national cohort survey.  Setting and participants Adult cancer patients diagnosed across all Health Boards in Scotland between July 2013 and March 2014, and who had an inpatient stay or hospital visit between January and September 2014. 2663 respondents (of n=4835 survey respondents) provided 6961 free-text comments.  Main outcome measures Positive and negative themes of patients’ experiences. Differences in the proportion of positive to negative comments by demographics.  Methods Data were analysed as follows: (1) comments were initially categorised at a high level (eg, positive, negative, miscellaneous, etc); (2) inductive codes were derived and applied to all relevant comments; (3) codes sharing similar meaning were amalgamated into subthemes, and code frequencies were measured; (4) subthemes were mapped into overarching themes; (5) difference in the proportion of positive to negative comments by demographics were analysed using χ2 tests.  Results Participants made more positive than negative comments (1:0.78). Analysis highlighted the importance to patients of Feeling that Individual Needs Are Met and Feeling Confident Within the System. Comments also provided insight into how Processes and Structures within the system of care can negatively impact on patients’ experience. Particular issues were identified with care experiences in the lead-up to diagnosis.  Conclusions This analysis provides a detailed understanding of patients’ cancer care experiences, therefore indicating what aspects matter in those experiences. Although the majority of comments were positive, there were a significant number of negative comments, especially about the lead-up to diagnosis. Comments suggest patients would value greater integration of care from services involved in their treatment for cancer