WINSTON-SALEM, N.C. –
March 13, 2018 – Say ordering a cancer screening test was as easy as booking
a hotel room online. Would that improve screening rates?
Doctors at Wake Forest Baptist Medical Center wanted to find
The physicians developed a specially designed iPad app with
which patients could order a colon cancer screening test while waiting for
their doctor. And many did just that.
In a randomized clinical trial, the app doubled the proportion
of patients who underwent colon cancer screenings. Findings from the study are
published in the early online edition of the April issue of Annals of Internal
Previous research has shown that screening for colon cancer
reduces mortality, yet more than one-third of age-eligible Americans go
unscreened every year. Colon cancer remains the second leading cause of cancer
death in the United States.
“Many barriers contribute to low screening rates, including
patients’ negative attitudes about the tests, lack of awareness of the need for
screening and competing demands for busy doctors’ scarce time,” said the
study’s lead author, David P. Miller, M.D., professor of internal medicine at
Wake Forest Baptist. “In the ideal world, a doctor should discuss the need for
screening with patients, inform them of the available options, help them make a
decision and then order the test. All of this takes time, time doctors may not
have if a patient has other concerns that need to be investigated.”
Called mobile Patient Technology for Health-CRC (mPATH-CRC),
the iPad application informs patients of their need for screening, helps them
make a screening decision, lets them “self-order” a screening test and sends
automated electronic messages to help them complete their chosen test.
In this study, researchers enrolled 450 patients in primary
care who were due for colon cancer screening. Participants were randomly assigned
to use the iPad app or receive usual care, with approximately half in each
Participants used mPATH-CRC at their primary care doctor’s
office on a device owned by the practice, and could request follow-up support
on their own personal devices. The app also presented educational information about
different types of screening tests – colonoscopy and fecal tests – so the
patient could order the test they wanted.
Those who used the app were twice as likely to undergo screening
compared to patients in the usual care group (30 percent versus 15 percent,
respectively). Half of patients who used the app ordered their own screening. That
saves doctors a lot of time, time they can use to address patients’ other
health concerns, Miller said.
“Digital health programs like the one we developed shouldn’t
replace doctors. Rather, they should help doctors deliver better care and
encourage patients to actively participate in their own care,” Miller said.
“As a primary care doctor, I don’t mind admitting the iPad
program can do a better job of teaching my patients about colon cancer
screening than I can. After all, the iPad can use animations and videos, and I
just have my voice and maybe some poorly drawn doodles.”
Miller added that while screening increased substantially in
the study, approximately half the patients failed to complete their ordered
tests. Incorporating more strategies to encourage patients to complete their
screening could further increase the effectiveness of mPATH-CRC.
Funding for the study was provided by the National Cancer
Institute, RO1CA178941, as well as institutional support from Wake Forest
Co-authors are: Nancy Denizard-Thompson, M.D.,
Kathryn E. Weaver, Ph.D., L. Doug Case, Ph.D., John G. Spangler, M.D., and
Donna Lawler, of Wake Forest Baptist; Jennifer L. Troyer, Ph.D., of the
University of North Carolina at Charlotte; and Michael P. Pignone, M.D., of the
University of Texas Dell Medical School.