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.

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1. To incorporate CRC risk assessment into Colorectal Web, an electronic preference-based decision aid to promote CRC screening.
2. To link Colorectal Web to ClinfoTracker, an innovative computerized prompt/reminder system, to generate a tailored patient preference/risk prompt to physicians.
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.

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.

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). <br><br>

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.<br><br>

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.<br><br>

Although the study is still being conducted, initial findings include:

• Practice physicians and staff desire a colorectal cancer screening behavioral improvement intervention that intuitively makes sense and blends well with their daily workflow.
• An electronic behavioral intervention that helps patients understand their preferences among the options of screening tests available for colorectal cancer significantly improves screening behavior.
• Feasibility study of an electronic behavioral intervention that exactly emulates the actual design of the planned larger study is key to discovering glitches and making necessary changes to increase recruitment and improve the overall process.
• Linking an electronic behavioral intervention to a physician visit, invitation letter by the patient's own physician, information brochure that emphasizes the importance of the research study and the participant's potential contribution, and reminder phone calls significantly improve recruitment rate.

<i>Initial thoughts based on this study as well as a prior study using the Colorectal Web website:</i><br>
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.

Jimbo M, Ruffin M, Nease D, Fetters, MD, Strecher V, Saunders E. Cancer screening adherence through technology-enhanced shared decision making. Family Medicine Digital Resources Library. Available at: http://www.fmdrl.org/index.cfm?event=c.beginBrowseD#740