Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case

Abstract

Purpose: Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.

Methods: Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey.

Results: In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%).

Conclusions: Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.

Keywords: computer-assisted; decision making; health information technology; patient education; practice-based research; primary care; screening.

Figure 1

Conceptual model for engaging patients through an informed decision-making module embedded in a patient portal and electronic health record. Note: To engage patients in their decision, the informed decision-making (IDM) module guides patients and clinicians through a series of 7 steps that can be applied to a wide range of decisions beyond the test case (cancer screening) investigated in this study. The IDM module (1) reaches patients outside the confines of an office visit to explore a potential decision by completing the module; (2) walks patients through an intake that assesses personal preferences, knowledge, and needs, and patients’ readiness to make a decision; (3) provides personalized educational material tailored to patients’ stated preferences and decision stage; (4) allows patients to share their preferences and decision needs with their clinician; (5) prompts patients and clinicians to use the reported information to make a decision; (6) guides the patient to make a choice, which can include deferring the decision; and (7) invites patients and clinicians to provide input after the encounter.

Figure 2

Relationship of the informed decision-making module with follow-up visits and with breast, colorectal, and prostate cancer screening. PSA = prostate-specific antigen. Note: Percentages of patients who received screening tests were derived from electronic health record data for a period of 3 months after completion of the decision module. Although the colorectal cancer screening rate appears low, this study included only the subset of practice patients overdue for that screening. On the basis of prior studies and practice quality program participation, about 70% of patients in the study practices have been screened for colorectal cancer.