Trial of a Computer-Based Presentation of Quantitative Information About Colorectal Cancer Screening
Condition: Colonic Neoplasms
MeSH terms: Colonic Neoplasms
Study type: Interventional

Summary: 
      Fifty thousand people die from colorectal cancer (CRC) every year, making it the second
      leading cause of death from cancer in the United States. And although there are multiple
      screening tests that reduce the morbidity and mortality of this disease, less than 60% of
      eligible individuals are up to date with recommended screening.

      One of the challenges to improving screening is helping patients understand the range of
      approved tests, including colonoscopy, sigmoidoscopy, and stool testing (such as fecal
      immunochemical testing (FIT)). Patients rarely consider all their options, partly due to the
      limited time they have to learn about them during busy doctor's visits.

      Computer-based presentations, including decision aids, are a promising tool for improving
      patient understanding in this and other areas, by giving patients significant amounts of
      information.

      But there are important questions about how to design such presentations, including whether
      they should provide quantitative data about the risks and benefits of screening. Some experts
      feel that these numbers and graphs are necessary for fully informed decision-making, while
      others are concerned that they may confuse patients or dissuade them from screening.

      The investigators have created and pilot tested a computer-based presentation of quantitative
      information about CRC screening. The investigators found that subjects who viewed the program
      in a non-healthcare setting exhibited significantly increased interest in screening. In
      addition, the investigators tested a version of the program that includes a "nudge" towards
      stool testing with FIT, as a way of encouraging individuals who are confused to undergo some
      form of screening. In our testing, receiving the nudge was associated with a significant
      increase in interest in FIT.

      The investigators now seek to conduct a randomized, controlled study of our computer-based
      presentation with Clarian patients who are due for CRC screening. All subjects will first
      view a general video about CRC screening and then will be randomly placed into four groups
      (using a 2x2 design), to receive quantitative information (or not), and a nudge towards FIT
      (or not).

      The results will determine whether a presentation of quantitative information can increase
      patient understanding, quality of decision-making, and uptake of CRC screening. The results
      will serve as pilot data for a larger, externally funded study of the effect of
      individualized ("personalized") quantitative information in this area
    


Intervention name(s): Control; Quantitative; Default
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Computer-based presentation regarding colorectal cancer (CRC) and screening for CRC with colonoscopy, sigmoidoscopy, or stool testing. Includes a video from the American Cancer Society.; Computer-based presentation providing quantitative information regarding (a) the lifetime average probability of getting CRC or dying from it, (b) the reduction in mortality provided by undergoing regular screening with colonoscopy, and (c) the reduction in mortality provided by undergoing regular screening with fecal immunochemical testing (FIT); Computer-based presentation that encourages subjects who are unwilling to undergo colonoscopy or are unsure about whether to undergo screening to get tested with Fecal Immunochemical Testing (FIT). This is labeled the "Default" intervention since it attempts to shift the "default" choice from "no screening" to FIT.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Colon cancer; Screening; Decision-making