Personalised Intervention And Colorectal Cancer Screening - EMJ

Personalised Intervention May Improve Appropriate Use of Colorectal Cancer Screening

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RECENT data suggest that older patients presented with personalised information about the benefits and harms of colorectal cancer (CRC) screening were more likely to receive screening orders that aligned with benefit, and less likely to utilise screening overall.

Study author Sameer D. Saini, from the VA Ann Arbor Healthcare System and Michigan Medicine, USA, stated: “A more systematic, scalable, and patient-centred approach is needed to guide older adults who may otherwise qualify for screening but have competing health issues that make the screening decision more complex.”

Saini and colleagues conducted an unmasked, randomised clinical trial among 431 average-risk adults (mean age: 71.5 years; 98.4% male; 86.8% White), at two United States Department of Veterans Affairs facilities, to evaluate the effect of personalised multilevel intervention on CRC screening orders. Patients in the intervention group (n=258) received detailed information on screening benefits and harms that was customised for each individual’s age, sex, screening history, and comorbidities. Those in the control group (n=173) received general screening information only. The primary outcome was whether CRC screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit, and utilisation within 6 months.

In a pre-specified interaction analysis, the proportion of patients receiving screening orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% versus 71.1%), and higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% versus 52.2%). At 6 months, fewer intervention patients (41.4%) had undergone CRC screening compared with controls (55.9%; adjusted difference: -13.4 percentage points; 95% confidence interval: –25.3–-1.6).

The authors emphasised that their findings were particularly notable considering that only a minority of the study participants were college-educated, and nearly one-third had limited health literacy. They concluded: “A multilevel intervention that presents older adults with personalised information about screening benefits and harms, together with clinician education and system-level support, has the potential to align screening orders with screening benefit and decrease overall use of screening.”

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