An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial

Trials

Tejinder Rakhra-Burris¹  Deborah A. Fisher²  Dawn Provenzale²  Lori A. Orlando³  Santanu K. Datta³  R. Ryanne Wu³  Maren T. Scheuner⁴  Elizabeth Strawbridge⁵  Virginia Wang⁵  Nina Sperber⁵  Karen M. Goldstein⁵  Cynthia J. Coffman⁵  Janet M. Grubber⁵  Elizabeth R. Hauser⁶  Richard E. Nelson⁷  Corrine I. Voils⁸ 

[1] Center for Applied Genomics and Precision Medicine, Duke University School of Medicine;Division of Gastroenterology, Department of Medicine, Duke University School of Medicine;Division of General Internal Medicine, Duke University School of Medicine;Division of Medical Genetics, University of California at San Francisco;Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System;Durham Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System;IDEAS Center, VA Salt Lake City Healthcare System;William S Middleton Memorial Veterans Hospital;

关键词: Risk assessment;    Family history;    Cancer screening;    Colorectal cancer;   

DOI  :  10.1186/s13063-019-3659-y

来源: DOAJ

【 摘 要 】

Abstract Background Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3–10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices. Methods In this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers’ experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective. Discussion This trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs. Trial registration ClinicalTrials.gov, NCT02247336. Registered on 25 September 2014.

【 授权许可】

Unknown