iPad app can boost colorectal cancer screening rates

Last Updated: 2018-03-14

By Marilynn Larkin

NEW YORK (Reuters Health) - An iPad application that lets patients self-order tests while they wait to see their doctor can increase colorectal cancer (CRC) screening rates, researchers say.

Dr. David P. Miller Jr. of Wake Forest School of Medicine in Winston-Salem, North Carolina and colleagues tested their intervention, Mobile Patient Technology for Health-CRC (mPATH-CRC), among patients at six community-based primary care practices who were scheduled to see their health care provider and were due for a CRC screening.

Four hundred and fifty patients (median age, 57, about half women) were randomly assigned to mPATH-CRC or a control program. Baseline characteristics were similar between groups: 38% self identified as African American; 37% had limited health literacy; and 53% had annual incomes under $20,000.

The mPATH-CRC program included a decision aid about CRC screening and a review of the fecal and colonoscopy tests. It also allowed patients to self-order their own screening test and receive electronic reminders.

The control program included a video about diet and exercise but did not give patients to option to self-order tests or receive follow-up reminders.

Both programs included identical baseline and post-program self-administered surveys to collect demographic information and assess short-term outcomes.

On the day of enrollment, participants completed the assigned program, then proceeded to their scheduled medical visits.

"We decided to have patients use the program while they waited for their doctor because this is often wasted time," Dr. Miller said in an email to Reuters Health. "We also saw this as providing 'just in time' information to patients. If patients used the program and had questions, they could immediately ask their doctor."

As reported online March 12 in Annals of Internal Medicine, participants in the mPATH-CRC group were twice as likely as controls to complete a screening test (30% vs. 15%). The odds ratio for completing screening was 2.5 in favor of mPATH-CRC after accounting for stratification by clinic.

On the post-program survey, 97% of mPATH-CRC participants could state a screening preference, compared with 71% of controls. Test ordering also was higher in the mPATH-CRC group (69% vs. 32%) and both fecal blood tests and colonoscopies were ordered more frequently for mPATH-CRC patients.

About half of mPATH-CRC participants (53%) self-ordered a test via the program.

Dr. Miller said, "I think letting patients order their own screening had a significant effect."

"We had done an earlier study with the decision aid and found it increased patients' knowledge of screening and their desire to be screened," he noted. "But only one third of patients who said they wanted screening actually had it ordered."

"So this time, we decided to let patients order their own tests," he explained. "Allowing patients to order their own tests removes additional steps where the ball could get dropped."

"As a next step, we will be working with practices to see how the mPATH program can be incorporated into usual workflow, without a research team being involved," he said. "We also want to find easy ways to help patients complete tests that are ordered, because that would increase the impact of mPATH even more."

Dr. David Asch of the University of Pennsylvania in Philadelphia, coauthor of an accompanying editorial, told Reuters Health, "This study appears to show that patient education delivered on an iPad can improve the rate of colorectal cancer screening."

"But a closer look at the intervention suggests that its effectiveness probably had little to do with either education or technology and instead derived from the study's behavioral design," he said by email.

"Allowing patients to order their own cancer screening allows them to precommit," he explained. "Readying those orders for the physicians to sign shifts the physician's default toward screening."

"Both of these behavioral devices are known to be highly motivating," he noted.

"Instead of trying to redirect patient and physician behavior with education," Dr. Asch concluded, "we should observe patients' and physicians' natural behaviors and put the better choices in their path."

SOURCE: http://bit.ly/2IqTbTJ and http://bit.ly/2IscWKj

Ann Intern Med 2018.