A Patient Portal-Based Commitment Device to Improve Adherence with Screening for Colorectal Cancer: a Retrospective Observational Study.
colorectal cancer screening
commitment device
patient portal
patient self-management
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
16
04
2020
accepted:
03
12
2020
pubmed:
22
1
2021
medline:
25
5
2021
entrez:
21
1
2021
Statut:
ppublish
Résumé
Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening. Compare the effectiveness of a commitment device (patient self-ordering fecal immunochemical test (FIT) kits) to standard CRC screening outreach. A retrospective observational study. Participants were > 49 years and < 75 years, had no history of CRC, and were eligible for CRC screening. An electronic screening reminder with an embedded order button allowed participants to order FIT kits directly from a patient portal. Those who used the order button were promptly sent a kit; those who did not were later mailed kits. Primary outcome was completion of FIT kits. Secondary outcomes included number of days to completion, completion of follow-up for positive results, and CRC diagnosis; we also examined prior use of FIT kit. We used inverse probability of treatment weights to control for pretreatment imbalances. The cohort comprised 176,231 participants: 53% female; median age was 59; 11% were Asian, 21% Hispanic/Latino, 7% black, 51% White, 3% other/mixed race. Approximately 10% (N = 16,918) used the button. Using inverse probability of treatment weights, we found that those who used the button had 3.8 times the odds of completing a kit compared to participants who did not (odds ratio, 3.77; 95% confidence interval, 3.57-3.98). Within the button group, 63% of those eligible completed a FIT kit in the year prior to the button compared to 87% in the year after the button became available (p < 0.0001). The ability to self-order screening kits may act as a commitment device that increases CRC screening. Scalable tools leveraging existing patient portals such as this can complement existing CRC outreach strategies.
Sections du résumé
BACKGROUND
Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening.
OBJECTIVE
Compare the effectiveness of a commitment device (patient self-ordering fecal immunochemical test (FIT) kits) to standard CRC screening outreach.
DESIGN
A retrospective observational study.
PARTICIPANTS
Participants were > 49 years and < 75 years, had no history of CRC, and were eligible for CRC screening.
INTERVENTION
An electronic screening reminder with an embedded order button allowed participants to order FIT kits directly from a patient portal. Those who used the order button were promptly sent a kit; those who did not were later mailed kits.
MAIN MEASURES
Primary outcome was completion of FIT kits. Secondary outcomes included number of days to completion, completion of follow-up for positive results, and CRC diagnosis; we also examined prior use of FIT kit. We used inverse probability of treatment weights to control for pretreatment imbalances.
KEY RESULTS
The cohort comprised 176,231 participants: 53% female; median age was 59; 11% were Asian, 21% Hispanic/Latino, 7% black, 51% White, 3% other/mixed race. Approximately 10% (N = 16,918) used the button. Using inverse probability of treatment weights, we found that those who used the button had 3.8 times the odds of completing a kit compared to participants who did not (odds ratio, 3.77; 95% confidence interval, 3.57-3.98). Within the button group, 63% of those eligible completed a FIT kit in the year prior to the button compared to 87% in the year after the button became available (p < 0.0001).
CONCLUSION
The ability to self-order screening kits may act as a commitment device that increases CRC screening. Scalable tools leveraging existing patient portals such as this can complement existing CRC outreach strategies.
Identifiants
pubmed: 33474640
doi: 10.1007/s11606-020-06392-y
pii: 10.1007/s11606-020-06392-y
pmc: PMC8042087
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
952-960Références
CA Cancer J Clin. 2018 Jul;68(4):250-281
pubmed: 29846947
Jt Comm J Qual Patient Saf. 2016 Jul;42(7):303-10
pubmed: 27301833
Stat Med. 2013 Aug 30;32(19):3388-414
pubmed: 23508673
J Med Internet Res. 2015 Feb 24;17(2):e52
pubmed: 25803266
J Med Internet Res. 2019 Apr 11;21(4):e12779
pubmed: 30973347
J Med Screen. 2015 Sep;22(3):119-26
pubmed: 25967088
J Med Internet Res. 2015 Feb 10;17(2):e44
pubmed: 25669240
J Ambul Care Manage. 2009 Oct-Dec;32(4):320-7
pubmed: 19888008
Ann Intern Med. 2020 Jun 2;172(11 Suppl):S123-S129
pubmed: 32479176
Eur J Public Health. 2019 Jun 1;29(3):413-418
pubmed: 30544169
J Med Internet Res. 2019 Aug 20;21(8):13743
pubmed: 31432782
Am J Prev Med. 2016 Jul;51(1):71-7
pubmed: 26826751
JAMA Intern Med. 2018 Dec 1;178(12):1645-1658
pubmed: 30326005
Manage Sci. 2014 Feb;60(2):283-299
pubmed: 25843979
J Pers Soc Psychol. 1966 Mar;3(3):349-53
pubmed: 5906339
J Med Internet Res. 2015 Jun 23;17(6):e148
pubmed: 26104044
Gastroenterology. 2018 Nov;155(5):1383-1391.e5
pubmed: 30031768
Patient Educ Couns. 2015 May;98(5):545-52
pubmed: 25744281
Prev Med. 2018 Jul;112:199-206
pubmed: 29729288
Ann Intern Med. 2018 Apr 17;168(8):592-593
pubmed: 29532079
BMC Med Inform Decis Mak. 2018 Oct 16;18(1):84
pubmed: 30326876
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
JAMA. 2014 May;311(20):2065-6
pubmed: 24777472
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
JAMA Intern Med. 2018 Dec 1;178(12):1658-1660
pubmed: 30326022
PLoS One. 2016 Jun 23;11(6):e0154743
pubmed: 27337092
J Am Med Inform Assoc. 2015 Apr;22(e1):e104-11
pubmed: 25030033
Health Aff (Millwood). 2013 Feb;32(2):216-22
pubmed: 23381513
Ann Intern Med. 2013 Mar 5;158(5 Pt 1):301-11
pubmed: 23460053
Ann Intern Med. 2018 Apr 17;168(8):550-557
pubmed: 29532054
JAMA. 2016 Jun 21;315(23):2564-2575
pubmed: 27304597
Health Aff (Millwood). 2013 Feb;32(2):376-84
pubmed: 23381531
J Am Med Inform Assoc. 2016 Apr;23(e1):e162-8
pubmed: 26335985
J Am Med Inform Assoc. 2019 Aug 1;26(8-9):855-870
pubmed: 30958532