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Although screening for colorectal cancer has been shown to decrease deaths from the disease, only about two-thirds of Americans are up to date with screening.
A 2018 study suggested that giving people an easy way to order their own screening tests may help increase the number of people who get screened.
In the NCI-funded study, people waiting to see their doctors for routine checkups were given a tablet computer loaded with an interactive app that provides information about the need for colorectal cancer screening, helps patients make decisions about screening, and allows them to “self-order” their own screening test.
People who used the app, the study showed, were twice as likely to be screened as those viewing a video that did not provide information about screening or the option to order a test.
The “interesting and innovative” aspect of the approach used in the new study is that “once patients made a choice about screening, they had the opportunity to order the test themselves,” said healthcare delivery researcher Caitlin Murphy, Ph.D., M.P.H., of the University of Texas Southwestern Medical Center, who was not involved in the new study.
Clinical Trial Included Those Most Likely to Face Barriers to Screening
The U.S. Preventive Services Task Force recommends screening for colorectal cancer for average-risk adults ages 50–75 with a colonoscopy once every 10 years or a stool-based test every year.
People with an abnormal stool test result (signs of blood in the stool) are advised to undergo a colonoscopy to investigate the cause.
Many factors contribute to low screening rates in the United States, including fear of the procedure and/or the preparation; lack of awareness of the need for screening; and absent or inadequate doctor–patient discussions about screening. Screening rates are particularly low among people with less education or low incomes.
Researchers have tested different approaches to increasing colorectal cancer screening rates, such as small financial incentives and mailed invitation letters and free testing kits, and found varying levels of success.
In the study, David P. Miller Jr., M.D., of Wake Forest School of Medicine, and his colleagues tested the Mobile Patient Technology for Health-CRC (mPATH-CRC) app, which they designed for people with low health literacy and low computer literacy, at six community-based primary care practices in North Carolina.
The 450 study participants were 50–74 years old, scheduled to see a primary care provider, and due for colorectal cancer screening.
The mPATH-CRC app tells patients about the two tests most commonly used to screen for colorectal cancer in the United States — colonoscopy and fecal occult blood testing, which looks for hidden (occult) blood in patient stool samples — and helps them decide which test to use.
Patients were randomly assigned to use either the mPATH-CRC app or a control app that included a video about diet and exercise and did not give patients the option to self-order screening tests.
Primary care providers of patients who self-ordered a screening test with the app were notified and asked to approve or deny the test order. Patients who self-ordered a screening test received a series of automated follow-up email or text messages to help them follow through with the test.
App Improved Screening but Left Room for Improvement
Of the participants assigned to the mPATH-CRC group, 30 percent completed a screening test within the study’s 24-week follow-up period, compared with 15 percent of people in the control group.
But the 30 percent screening rate “is still far from ideal,” Miller said.
Researchers did look at detection of colon polyps (precancerous growths) and cancers in both groups. They found 15 people with polyps and one with cancer among those who used the app, compared with only six people with polyps in the control group.
“That suggests that for every 22 people who use the app, we’ll find polyps in one extra person — and that’s potentially one person we will prevent from getting colon cancer,” Miller said.
The researchers were surprised to find that roughly half (53 percent) of patients in the mPATH-CRC group ordered a test for themselves via the app. This was a higher number than expected, Miller said.
Source: National Cancer Institute