Impact of Family History and Decision Support on High-risk Cancer Screening

Eligible patients are aged 40-65 years, enrolled in primary care, do not have a personal history of colorectal cancer, and have some knowledge of family health history. In Aim 1, a retrospective chart review will be conducted to determine the baseline rate of documenting family health history of colorectal cancer in the medical record for patients enrolled in the Aim 2 randomized trial. In Aim 2, consented patients will be randomized to provide patient-entered family health history and receive patient and provider decision support at enrollment or 12 months later (wait-list control). The primary outcome is risk-appropriate CRC screening/surveillance referral for patients 12 months post-enrollment. Secondary outcomes include patient uptake of recommendations and referral for genetic consultation 12 months post-enrollment. In Aim 3, qualitative interviews will be conducted with physicians and clinic leaders; data will be analyzed using conventional content analysis. In Aim 4, data will be obtained from the administrative databases and patient medical records to conduct a budget impact analysis.

Inclusion criteria

Primary care provider inclusion criteria:

• primary care physician,
• physician assistant, or nurse practitioner;
• at least one half-day of primary care clinic per week.

Patient inclusion criteria:

• assigned to an enrolled PCP;
• English as preferred language;
• no plans to relocate or leave the VA system in the next 12 months;
• at least one primary care appointment in the 18 months prior to enrollment;
• upcoming PCP appointment with assigned PCP;
• aged 40-64 years; no previous history of colorectal cancer or adenomatous polyps or inflammatory bowel disease;
• no endoscopy within previous 3 years; some knowledge of family health history

Exclusion criteria

n/a (contained within inclusion criteria)