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A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer.

Publication ,  Journal Article
Voils, CI; Coffman, CJ; Wu, RR; Grubber, JM; Fisher, DA; Strawbridge, EM; Sperber, N; Wang, V; Scheuner, MT; Provenzale, D; Nelson, RE ...
Published in: J Gen Intern Med
May 2023

BACKGROUND: Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE: To examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk. DESIGN: Two-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control. PARTICIPANTS: PCPs treating patients at least one half-day per week; patients aged 40-64 with no medical conditions that increased CRC risk. INTERVENTIONS: Immediate-arm patients entered their FHH into a web-based platform that provided risk assessment and guideline-driven decision support; wait-list control patients did so 12 months later. MAIN MEASURES: McNemar's test examined differences between the platform and electronic medical record (EMR) in rates of increased risk documentation. General estimating equations using logistic regression models compared arms in risk-concordant provider actions and patient screening test completion. Referral for genetic consultation was analyzed descriptively. KEY RESULTS: Seventeen PCPs were randomized to each arm. Patients (n = 252 immediate, n = 253 control) averaged 51.4 (SD = 7.2) years, with 83% assigned male at birth, 58% White persons, and 33% Black persons. The percentage of patients identified as increased risk for CRC was greater with the platform (9.9%) versus EMR (5.2%), difference = 4.8% (95% CI: 2.6%, 6.9%), p < .0001. There was no difference in PCP risk-concordant action [odds ratio (OR) = 0.7, 95% CI (0.4, 1.2; p = 0.16)]. Among 177 patients with a risk-concordant screening test ordered, there was no difference in test completion, OR = 0.8 [0.5,1.3]; p = 0.36. Of 50 patients identified by the platform as increased risk, 78.6% immediate and 68.2% control patients received a recommendation for genetic consultation, of which only one in each arm had a referral placed. CONCLUSIONS: FHH tools could accurately assess and document the clinical needs of patients at increased risk for CRC. Barriers to acting on those recommendations warrant further exploration. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02247336 https://clinicaltrials.gov/ct2/show/NCT02247336.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2023

Volume

38

Issue

6

Start / End Page

1375 / 1383

Location

United States

Related Subject Headings

  • Risk Assessment
  • Referral and Consultation
  • Male
  • Logistic Models
  • Infant, Newborn
  • Humans
  • General & Internal Medicine
  • Colorectal Neoplasms
  • Colonoscopy
  • 4206 Public health
 

Citation

APA
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Voils, C. I., Coffman, C. J., Wu, R. R., Grubber, J. M., Fisher, D. A., Strawbridge, E. M., … Goldstein, K. M. (2023). A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med, 38(6), 1375–1383. https://doi.org/10.1007/s11606-022-07787-9
Voils, Corrine I., Cynthia J. Coffman, R Ryanne Wu, Janet M. Grubber, Deborah A. Fisher, Elizabeth M. Strawbridge, Nina Sperber, et al. “A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer.J Gen Intern Med 38, no. 6 (May 2023): 1375–83. https://doi.org/10.1007/s11606-022-07787-9.
Voils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, et al. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med. 2023 May;38(6):1375–83.
Voils, Corrine I., et al. “A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer.J Gen Intern Med, vol. 38, no. 6, May 2023, pp. 1375–83. Pubmed, doi:10.1007/s11606-022-07787-9.
Voils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, Sperber N, Wang V, Scheuner MT, Provenzale D, Nelson RE, Hauser E, Orlando LA, Goldstein KM. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med. 2023 May;38(6):1375–1383.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

May 2023

Volume

38

Issue

6

Start / End Page

1375 / 1383

Location

United States

Related Subject Headings

  • Risk Assessment
  • Referral and Consultation
  • Male
  • Logistic Models
  • Infant, Newborn
  • Humans
  • General & Internal Medicine
  • Colorectal Neoplasms
  • Colonoscopy
  • 4206 Public health