Personalized risk messages improve uptake of colorectal cancer screening

A recent study has shown that the inclusion of personalized risk for advanced colorectal neoplasia (ACN) in a decision aid or provider notification provides no overall effect, but it has led to an increase in the uptake of stool testing in one health system.

This randomized controlled trial was conducted in primary care clinics in two healthcare systems, involving 214 providers and 1,084 average-risk patients due for screening.

The investigators randomized the participants to view a CRC screening decision aid, with or without a personalized message about ACN risk. They also randomized providers to receive notifications that the patient was due for screening, with or without a personalized message about the patient’s ACN risk.

Overall, no differences were seen in screening uptake or test completion for the provider notification (predicted probabilities, 41.5 percent vs 36.4 percent for personalized vs generic; difference, 5.1 percentage points, 95 percent confidence interval [CI], –1.6 to 11.8) or decision aid interventions (predicted probabilities, 36.8 percent vs 41.0 percent; difference, –4.1 percentage points, 95 percent CI, –10.2 to 1.9).

Notably, the health system moderated the effect for stool testing. 

When the decision aid was generic, the stool testing rate was higher for personalized vs generic provider notification (predicted probabilities, 21.1 percent vs 7.9 percent; difference, 13.2 percentage points, 95 percent CI, 1.6–24.8) in one health system.

When the provider notification was generic, the rate of stool testing was higher for the personalized than the general decision aid (predicted probabilities, 21.4 percent vs 7.9 percent; difference, 13.5 percentage points, 95 percent CI, 2.4–24.5).