Pilot of Decision Support to Individualize Colorectal Cancer Screening Recommendations

Objectives: To test the feasibility of using an electronic medical record (EMR)-based decision support system (DSS) that incorporates morbidity and frailty information to individualize colorectal cancer (CRC) screening recommendations. Study Design: Our framework used the payoff time, defined as the minimum time until the benefits of screening exceed the harms. Methods: Subjects were 24 patients eligible for CRC screening and 22 primary care providers (PCPs). Measures included PCP satisfaction with existing reminder systems and with decision support. Results: The run-in phase, during which the intervention was inactive but its performance was verified, had 14 patients enrolled. The intervention phase, during which payoff time and life expectancy calculations were used to recommend for or against CRC screening, had 10 patients enrolled. Of the 10 patients enrolled in the intervention phase, the DSS recommended in favor of CRC screening for 6 patients. (The PCPs also recommended it for those 6 patients, although 3 refused the screening.) The DSS recommended against CRC screening for 4 patients, while the PCPs recommended against it for 3 of those 4 and ordered the screening for 1 patient. PCPs who had patients enrolled in the intervention phase indicated interest in having payoff time information for all patients eligible for CRC screening. This pilot study was small and was not powered to determine the effect of the intervention on screening behavior. Conclusions: Colorectal cancer screening involves balancing immediate harms with longer-term benefits; EMR decision support may facilitate personalized benefit/harm assessment. The payoff time framework is feasible for implementation in EMR decision support.