Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults

Kistler, Christine E.; Golin, Carol E.; Morris, Carolyn; Dalton, Alexandra F.; Harris, Russell; Dolor, Rowena J; Ferrari, Renée M.; Brewer, Noel T.; Lewis, Carmen L.

doi:10.1177/1740774517725289

Cited by 7 publications

(13 citation statements)

References 64 publications

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“…Commensurate with previous reviews on this topic [ 6 , 7 ], a majority of articles analyzed reported improvement in practitioner performance [ 16 - 18 , 21 , 23 - 25 , 28 - 31 , 33 - 35 , 37 , 38 , 40 , 44 , 45 , 47 - 50 ], but contrary to the previous reviews, our review found articles that reported patient outcomes, and a majority were positive outcomes [ 15 , 17 , 20 , 21 , 23 , 26 , 27 , 31 , 32 , 34 , 35 , 37 , 39 , 41 - 48 , 50 ]. Although 9 articles did not discuss practitioner performance [ 15 , 20 , 26 , 27 , 32 , 39 , 41 , 43 ], only 5 articles reported no difference in productivity [ 19 , 22 , 36 , 42 , 46 ].…”

Section: Discussionmentioning

confidence: 62%

“…Overall , the research generally supports the efficiency of CDSS technologies for practitioner performance [ 16 - 18 , 21 , 23 - 25 , 28 - 31 , 33 - 35 , 37 , 38 , 40 , 44 , 45 , 47 - 50 ] and effectiveness in patient medical outcomes [ 15 , 17 , 20 , 21 , 23 , 26 , 27 , 31 , 32 , 34 , 35 , 37 , 39 , 41 - 48 , 50 ]; however, a further in-depth review of their effectiveness, in particular for aspects such as the avoidance of alert fatigue and extension of CDSS utility, is important. Decision-support tools extend beyond the practitioner to the patient, and some tools are not software-based but based on patient-reported data [ 46 ].…”

Section: Discussionmentioning

confidence: 68%

“…Practitioner performance was reported as more accurate prescribing, improved screening of patients, improved overall performance, increased awareness of patient conditions, improved follow-up due to better communication with patients, improved accuracy of diagnosis, improved documentation, improved benchmarking, improved care plans, and improved buy-in of CDSSs. A total of 21% (8/38) of articles did not discuss practitioner performance [ 15 , 20 , 26 , 27 , 32 , 39 , 41 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…As illustrated, 61% (22/36) of occurrences of themes identified 7 positive patient medical outcomes as a result of using CDSSs [ 15 , 17 , 20 , 21 , 23 , 26 , 27 , 31 , 32 , 34 , 35 , 37 , 39 , 41 - 48 , 50 ]. Patients experienced improved symptoms [ 20 , 23 , 26 , 41 , 43 , 46 - 48 , 50 ], improved feedback from provider [ 17 , 31 , 42 , 45 ], improved disease management [ 21 , 35 , 37 ], improved efficacy of treatment [ 32 , 39 ], improved screening [ 15 , 27 ], and improved safety [ 34 ], and one study even reported improved mortality [ 44 ]. Although 11 articles did not discuss patient medical outcomes [ 16 , 18 , 19 , 24 , 25 , 28 - 30 , 33 , 40 , 49 ], only 3 reported no statistically significant difference in outcomes between control and intervention groups [ 22 , 36 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review

Kruse¹,

Ehrbar²

2020

JMIR Med Inform

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Background Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. Objective The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. Methods Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. Results Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 68%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review

Kruse¹,

Ehrbar²

2020

JMIR Med Inform

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“…Of those that identified performance, 82% (14/17) identified positive effect on practitioner performance as a result of using CDSS. Ten articles (37%) did not discuss practitioner performance (16,17,(20)(21)(22)24,26,30,32,34).…”

Section: Table 2: Summary Of Themes Identified For Practitioner Perfomentioning

confidence: 99%

What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes

Kruse¹,

Ehrbar²

2019

Preprint

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Background Computerized decision support systems (CDSS) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSS, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. The purpose of this review was to analyze the relationship between CDSS, practitioner performance, and patient medical outcomes. PubMed, CINAHL, and Cochrane databases were queried.Methods 27 articles were chosen based on year published (last ten years), high quality source, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet to collect information on the relationship between CDSS and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, and outcomes (PICO) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse Protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting.Results Fourteen articles (52%) discussed positive practitioner performance, three articles (11%) found no difference in practitioner performance, ten articles (37%) did not discuss practitioner performance. Zero articles reported negative practitioner performance. Fifteen articles (56%) discussed positive patient medical outcomes, two articles (7%) found no statistically significant difference in medical outcomes between intervention and control groups, and ten articles (37%) did not discuss medical outcomes. Zero articles found negative patient medical outcomes.Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found significant positive reporting of a positive effect on patient medical outcomes. Our findings support adoption of decision support systems.

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Effect of a Patient Decision Aid on Preferences for Colorectal Cancer Screening Among Older Adults

et al. 2022

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ImportanceGuidelines recommend individualized decision-making for colorectal cancer (CRC) screening among adults aged 76 to 84 years, a process that includes a consideration of health state and patient preference.ObjectiveTo determine whether a targeted patient decision aid would align older adults’ screening preference with their potential to benefit from CRC screening.Design, Setting, and ParticipantsThis is a prespecified secondary analysis from a randomized clinical trial. Participants aged 70 to 84 years who were not up to date with screening and had an appointment within 6 weeks were purposively sampled by health state (poor, intermediate, or good) at 14 community-based primary care practices and block randomized to receive the intervention or control. Patients were recruited from March 1, 2012, to February 28, 2015, and these secondary analyses were performed from January 15 to March 1, 2022.InterventionsPatient decision aid targeted to age and sex.Main Outcomes and MeasuresThe primary outcome of this analysis was patient preference for CRC screening. The a priori hypothesis was that the decision aid (intervention) group would reduce the proportion preferring screening among those in poor and intermediate health compared with the control group.ResultsAmong the 424 participants, the mean (SD) age was 76.8 (4.2) years; 248 (58.5%) of participants were women; and 333 (78.5%) were White. The proportion preferring screening in the intervention group was less than in the control group for those in the intermediate health state (34 of 76 [44.7%] vs 40 of 73 [54.8%]; absolute difference, −10.1% [95% CI, −26.0% to 5.9%]) and in the poor health state (24 of 62 [38.7%] vs 33 of 61 [54.1%]; absolute difference, −15.4% [95% CI, −32.8% to 2.0%]). These differences were not statistically significant. The proportion of those in good health who preferred screening was similar between the intervention and control groups (44 of 74 [59.5%] for intervention vs 46 of 75 [61.3%] for control; absolute difference, −1.9% [95% CI, −17.6% to 13.8%]).Conclusions and RelevanceThe findings of this secondary analysis of a clinical trial did not demonstrate statistically significant differences in patient preferences between the health groups. Additional studies that are appropriately powered are needed to determine the effect of the decision aid on the preferences of older patients for CRC screening by health state.Trial RegistrationClinicalTrials.gov Identifier: NCT01575990

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Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults

Cited by 7 publications

References 64 publications

Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review

Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review

What are the Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes

Effect of a Patient Decision Aid on Preferences for Colorectal Cancer Screening Among Older Adults

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