Effect of a Digital Health Intervention on Decreasing Barriers and Increasing Facilitators for Colorectal Cancer Screening in Vulnerable Patients

Abstract

Background: Colorectal cancer is the second leading cause of cancer-related death in the United States, in part, because one third of Americans fail to get screened. In a prior randomized controlled trial, we found that an iPad patient decision aid called Mobile Patient Technology for Health-CRC (mPATH-CRC) doubled the proportion of patients who completed colorectal cancer screening.

Methods: All data for the current analysis were collected as part of a randomized controlled trial to determine the impact of mPATH-CRC on receipt of colorectal cancer screening within 24 weeks. Participants were enrolled from six community-based primary care practices between June 2014 and May 2016 and randomized to either usual care or mPATH-CRC. Six potential mediators of the intervention effect on screening were considered. The Iacobucci method was used to assess the significance of the mediation.

Results: A total of 408 patients had complete data for all potential mediators. Overall, the potential mediators accounted for approximately three fourths (76.3%) of the effect of the program on screening completion. Perceived benefits, self-efficacy, ability to state a screening decision, and patient-provider discussion were statistically significant mediators. Patient-provider discussion accounted for the largest proportion of the effect of mPATH-CRC (70.7%).

Conclusions: mPATH-CRC increased completion of colorectal cancer screening by affecting patient-level and system-level mediators. However, the most powerful mediator was the occurrence of a patient-provider discussion about screening. Digital interventions like mPATH-CRC are an important adjunct to the patient-provider encounter.

Impact: Understanding the factors that mediated mPATH-CRC's success is paramount to developing other effective interventions.

Figure 1:. Overview of timing of study measures

The figure illustrates how the study design was administered. One week prior to the PCP visit the patient underwent a phone eligibility survery. At the day of the visit participants viewed mPATH-CRC or the Control Program and completed a post-program survey that captured attitudes and beliefs about screening immediately prior to their regularly scheduled primary care appointment. Telephone surveys were administered the next business day to determine if the patients discussed screening with their PCPs; and 24 weeks after the screening visit to determine if screening was ordered and completed. *PCP = Primary care provider