Project Overview +

Streamlining Cancer Screening Decision through Information Technology (SCanIT) aims to use information technology to link colorectal cancer (CRC) screening with health services at an integrated health system. The goal is to enhance informed decision making (IDM) for the patient and shared decision-making (SDM) between the patient and the physician.

Aims +

Aim 1. Refine Colorectal Web to provide an additional process for the patients to request a home fecal occult blood test (FOBT) kit if they independently decide to have FOBT as the CRC screening option.

Aim 2. Extend the existing linkage between Colorectal Web and Cielo Clinic(TM) to include the integrated health system's lab and clinical information systems to streamline the home FOBT and office SDM processes.

Aim 3. Test the feasibility and process of this model on a small sample of patients within the integrated health system.

Participants +

Twenty people from primary care practice clinics in St. John Health System, Michigan. Five patients each from the following groups: white men, white women, black men, and black women. Each patient is between 50 and 80 years old and has an upcoming scheduled health maintenance or chronic care visit.

Intervention +

Four weeks before a planned visit, patients due for CRC screening are identified and sent a recruitment letter with patient-specific website access information (a website URL and an unique ID they can type in) that enables them to securely access the Colorectal Web program.

Once patients access Colorectal Web, they 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 receive a summary of their risk, 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. Cielo Clinic (TM) receives the results, saves the data to the patient's electronic record, and provides it to the physician before each patient's next visit. It also records whether patients decide on completing a home FOBT, and if available, the FOBT results.

Patients receive a telephone interview prior to the scheduled health maintenance examination to assess their experience regarding Colorectal Web. When patients arrive at the clinic for their appointment, a research assistant (RA) places a small audiotape recorder in the examination room to capture the conversations of the patient-physician encounter. When the physician visit is done, the patient is asked to complete a brief paper and pencil questionnaire.

A physician questionnaire is sent to the physicians through their secure work e-mail on the day of the patient encounter. Additionally, participating physicians will undergo an informal focus group at the end of the study during one of their regular practice meetings. Follow-up will be for 2 years. Data is collected at 1 and 2 years by billing data for CRC screening tests and random chart audits, and at 1 and 2 years by patient and physician self-report surveys by postal mail and telephone.

Findings +

SCanIT

05/01/2007 - 04/30/2008

Sponsor(s)

Michigan Institute for Clinical and Health Research

Principal Investigator:

Masahito Jimbo, MD, PhD, MPH

Co-Investigator(s):

Mack T. Ruffin IV, MD, MPH