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

Goldstein KM1,2, Fisher DA3, Wu RR4,5,6, Orlando LA4,6, Coffman CJ7,8, Grubber JM7, Rakhra-Burris T6, Wang V7,4,9, Scheuner MT10,11, Sperber N7,9, Datta SK4,12, Nelson RE13,14, Strawbridge E7, Provenzale D3,5, Hauser ER5,8, Voils CI15,16.

Author information

1: Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. karen.goldstein@duke.edu.
2: Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. karen.goldstein@duke.edu.
3: Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
4: Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
5: Durham Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA.
6: Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA.
7: Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
8: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
9: Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
10: Division of Medical Genetics, University of California at San Francisco, San Francisco, CA, USA.
11: Division of Hematology-Oncology, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
12: Health Services Research, Management and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA.
13: IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.
14: Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
15: William S Middleton Memorial Veterans Hospital, Madison, WI, USA.
16: Department of Surgery, University of Wisconsin, Madison, WI, USA.

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.