Effect of a digital health intervention on receipt of colorectal cancer screening in vulnerable patients : A randomized controlled trial
Mené aux Etats-Unis auprès de 450 patients socio-économiquement défavorisés (âge médian : 57 ans), cet essai évalue, du point de vue du taux de participants ayant bénéficié d'un test de dépistage du cancer colorectal dans les 24 semaines, l'efficacité d'une application numérique pour iPad permettant aux patients de commander un test de dépistage et envoyant automatiquement à ces derniers des messages d'encouragement
Background : Screening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened.
Objective : To examine the effect of a digital health intervention, Mobile Patient Technology for Health–CRC (mPATH-CRC), on rates of CRC screening.
Design : Randomized clinical trial. (ClinicalTrials.gov: NCT02088333)
Setting : 6 community-based primary care practices.
Participants : 450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening.
Intervention : An iPad application that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients.
Measurements : The primary outcome was chart-verified completion of CRC screening within 24 weeks. Secondary outcomes were ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests. All outcome assessors were blinded to randomization.
Results : Baseline characteristics were similar between groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20 000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression OR, 2.5 [95% CI, 1.6 to 4.0]). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) “self-ordered” a test via the program.
Limitation : Participants were English speakers in a single health care system.
Conclusion : A digital health intervention that allows patients to self-order tests can increase CRC screening. Future research should identify methods for implementing similar interventions in clinical care.
Primary Funding Source : National Cancer Institute.
Annals of Internal Medicine , article en libre accès, 2017