CRC screening completion not improved by personalizing risk info

Providing personalized information about risk to patients and clinicians did not appear to affect overall rates of screening for colorectal cancer (CRC), a recent study found.

Researchers performed a randomized controlled trial at 41 primary care clinics in two health systems in the midwestern U.S. to evaluate whether information about patient risk for advanced colorectal neoplasia (ACN) improved uptake of CRC screening. Patients were randomly assigned to view a CRC screening decision aid with or without a personalized message about ACN risk, and clinicians were randomly assigned to receive notifications that a patient was due for screening with or without a message about specific ACN risk. The researchers hypothesized that personalized messages would increase uptake of screening overall, increase uptake of colonoscopy in patients at higher risk, and increase uptake of stool testing in patients at lower risk. The primary outcome was completion of a CRC screening test by six months. Results were published Sept. 2 by Annals of Internal Medicine.

The trial was conducted from November 2020 through May 2023. The analysis included 214 clinicians (106 in the generic group and 108 in the personalized group) and 1,084 average-risk patients due for CRC screening (537 in the generic group and 547 in the personalized group). Mean patient age was 56.5 years, and 88% were younger than age 65 years. More than half (59.7%) were women, 65.1% were White, and 96.7% were non-Hispanic. Sixty-three percent of patients had a low or very low ACN risk score, 31.9% had an intermediate risk score, and 5.1% had a high-average risk score.

Overall, 18.5% of patients completed a colonoscopy and 21.2% completed stool testing. There were no differences in screening uptake or test completion with the clinician notification intervention (predicted probabilities, 41.5% vs. 36.4% for personalized vs. generic; difference, 5.1 percentage points [95% CI, −1.6 to 11.8 percentage points]) or the patient decision aid intervention (predicted probabilities, 36.8% vs. 41.0% for personalized vs. generic; difference, −4.1 percentage points [95% CI, −10.2 to 1.9 percentage points]).

The health system where care was provided appeared to be an effect moderator for stool testing, the study found. In health system 1, the completion rate for stool testing was higher with personalized versus generic clinician notification when the decision aid was generic (predicted probabilities, 21.1% vs. 7.9%; difference, 13.2 percentage points [95% CI, 1.6 to 24.8 percentage points]) and with the personalized versus generic decision aid when the clinician notification was generic (predicted probabilities, 21.4% vs. 7.9%; difference, 13.5 percentage points [95% CI, 2.4 to 24.5 percentage points]). No intervention effects were seen in health system 2.

The study included only English-speaking patients, and few patients were at high-average ACN risk, the authors noted. They concluded that providing personalized risk information about ACN risk to patients and clinicians had no overall effect on CRC screening uptake or test completion.

“In one health care system, however, the personalized risk messages increased uptake of stool testing. Furthermore, among participants who attended their clinic visit in both health systems, those who were sent the personalized decision aid had lower odds of completing a colonoscopy,” they wrote. “These findings require confirmation and extension in subsequent studies, with potential to improve the uptake, effectiveness, and efficiency of CRC screening.”