Project Overview +

Cancer Screening Adherence through Technology-Enhanced Shared Decision Making (CSATS) is a tailored behavioral intervention to improve patient adherence to colorectal cancer screening (CRC). CSATS links a computerized screening prompt/reminder system with a tailored behavioral intervention. The intervention combines a screening decision aid with a risk assessment. Upon completion of the intervention, a recommendation is provided to both patient and physician to enhance shared decision making between the two.

Aims +

Aim 1. To incorporate CRC risk assessment into Colorectal Web, an electronic preference-based decision aid to promote CRC screening.

Aim 2. To link Colorectal Web to ClinfoTracker, an innovative computerized prompt/reminder system, to generate a tailored patient preference/risk prompt to physicians.

Aim 3. To test the feasibility of using CSATS in primary care physician (PCP) offices for patients ages 50 to 74 who present for health maintenance examination.

Participants +

Twenty participants ages 50 and 74 who have not had CRC screening; 5 each (male/female/black/white) drawn from two UM Family Medicine clinics.

Intervention +

ClinfoTracker, the University of Michigan's prompt/reminder system, identifies 200 eligible patients due for CRC screening. Patients access Colorectal Web to receive information about CRC, review details of their screening choices (including how they are done and pros and cons of each test), complete a CRC risk assessment, and use a screening preference tool to evaluate which screening criteria matches their preferences (cost, accuracy, convenience, discomfort, embarrassment, preparation, frequency, risk, need for additional tests, and sedation).

Patients get a summary of their risk, their screening preferences, and the test they are most willing to complete. Patients are asked to print their results and bring them to their upcoming physician appointment. ClinfoTracker receives the results, saves the data to the patient's electronic record, and provides it to the physician before the patient's next visit.

The patient's next visit with the physician is audio taped. The patients are asked to complete a brief questionnaire about the website and their physician visit. A Physician Questionnaire is sent to the physicians through e-mail on the day of the patient encounter.

Findings +

In this 1-year developmental project, an interactive Personal Risk Assessment Tool was added to an interactive decision aid originally developed by Dr. Ruffin, Colorectal Web (CW), to enable recommendation stratification by colorectal cancer (CRC) risk. Dr. Jimbo also tested the feasibility of the currently proposed approach to implementing and evaluating CW in 2 university-based family practices. Patient recruitment rate was 20%, and retention rate was 90%, and patient and physician satisfaction were 100%. All 20 patients recruited found the improved CW to be very easy to understand and use. Refinements made during the studies to improve recruitment and retention led to progressively better results.

Conclusion +

CRC screening can be increased through behavioral interventions that build a foundation for shared decision making between patients and their physicians.

By educating the patient on the screening tools available and allowing them to indicate their preferences in relation to those screenings, patients become more informed and can communicate better with their physician during visits.

By connecting electronic information from these interventions to a patient's medical record before an office visit, a physician can become more informed of a patient's desires and choices, which can help facilitate next steps for completing screenings.


01/02/2006 - 08/31/2007


National Cancer Institute

Principal Investigator:

Masahito Jimbo, MD, PhD, MPH