Effect of Personalized Risk Messages on Patient Intent and Decision Making in Colorectal Cancer Screening: A Randomized Controlled Trial

PurposeTo measure the impact of a personalized message about current risk of having advanced colorectal neoplasia (ACN; colorectal cancer [CRC] or advanced precancerous polyp) on informed concordance and CRC screening decision-making outcomes.MethodsA total of 1,084 patients, aged 50 to 75 y, with an upcoming clinic appointment, due for CRC screening, and at average risk for CRC were randomized to view a decision aid (DA) about CRC screening with or without personalized ACN risk information. Providers were randomized to receive CRC screening notifications with or without each patient's personalized ACN risk. Patients completed surveys before (T0), immediately after viewing the DA (T1), and after their clinic visit (T2) to assess informed concordance (primary outcome), screening intent, decisional conflict, knowledge, perceived personal risk, and perceived shared decision making. Analysis of covariance and logistic regression models compared intended screening behavior and decision-making outcomes by intervention groups.ResultsAt T1, participants (mean age 56.5 y, 59.7% female) sent the personalized rather than the generic DA had higher odds of intending to be screened with any test (odds ratio [OR] = 1.55, confidence interval [CI] = 1.03, 2.33) and to have a stool test (OR = 2.17, CI = 1.62, 2.91) and lower odds of intending to undergo colonoscopy (OR = 0.58, CI = 0.43, 0.79). There were no statistically significant effects of either intervention on informed concordance. Moderation analysis, however, showed that for one health system, participants whose provider was sent the personalized notification had higher odds of informed concordance.LimitationsSingle Midwestern city, English-speaking patients only, low enrollment of patients at high-average risk for ACN.ConclusionProviding patients with a personalized message about their ACN risk increased the intent to be screened and to do a stool test and decreased the intent to undergo colonoscopy. For one health system, sending providers the ACN risk message increased the odds of informed concordance.ClinicalTrials.gov: NCT04683731HighlightsA personalized message about patients' advanced colorectal neoplasia (ACN) risk, provided as part of a decision aid, increased patients' intent to be screened with any test and to have a stool test and decreased their intent to be screened with colonoscopy.A personalized message about patients' ACN risk, included in a decision aid sent to patients or in a screening notification sent to their providers, had no significant effect on informed concordance.At one health system, a personalized message sent to providers about their patients' ACN risk increased the odds of informed concordance between the patients' intended screening test and the test received.