• Corrine I Voils, Cynthia J Coffman, R Ryanne Wu, Janet M Grubber, Deborah A Fisher, Elizabeth M Strawbridge, Nina Sperber, Virginia Wang, Maren T Scheuner, Dawn Provenzale, Richard E Nelson, Elizabeth Hauser, Lori A Orlando, and Karen M Goldstein.
• William S. Middleton Memorial Veterans Hospital, Madison, WI, USA. corrine.voils@va.gov.
• J Gen Intern Med. 2023 May 1; 38 (6): 137513831375-1383.

BackgroundObtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging.ObjectiveTo examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk.DesignTwo-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control.ParticipantsPCPs treating patients at least one half-day per week; patients aged 40-64 with no medical conditions that increased CRC risk.InterventionsImmediate-arm patients entered their FHH into a web-based platform that provided risk assessment and guideline-driven decision support; wait-list control patients did so 12 months later.Main MeasuresMcNemar's test examined differences between the platform and electronic medical record (EMR) in rates of increased risk documentation. General estimating equations using logistic regression models compared arms in risk-concordant provider actions and patient screening test completion. Referral for genetic consultation was analyzed descriptively.Key ResultsSeventeen PCPs were randomized to each arm. Patients (n = 252 immediate, n = 253 control) averaged 51.4 (SD = 7.2) years, with 83% assigned male at birth, 58% White persons, and 33% Black persons. The percentage of patients identified as increased risk for CRC was greater with the platform (9.9%) versus EMR (5.2%), difference = 4.8% (95% CI: 2.6%, 6.9%), p < .0001. There was no difference in PCP risk-concordant action [odds ratio (OR) = 0.7, 95% CI (0.4, 1.2; p = 0.16)]. Among 177 patients with a risk-concordant screening test ordered, there was no difference in test completion, OR = 0.8 [0.5,1.3]; p = 0.36. Of 50 patients identified by the platform as increased risk, 78.6% immediate and 68.2% control patients received a recommendation for genetic consultation, of which only one in each arm had a referral placed.ConclusionsFHH tools could accurately assess and document the clinical needs of patients at increased risk for CRC. Barriers to acting on those recommendations warrant further exploration.Trial Registration NumberClinicalTrials.gov NCT02247336 https://clinicaltrials.gov/ct2/show/NCT02247336.© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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