Effect of a Digital Health Intervention on Decreasing Barriers and Increasing Facilitators for Colorectal Cancer Screening in Vulnerable Patients

Abstract

Background:Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, in part because one-third of Americans fail to get screened. In a prior randomized controlled trial, we found that an iPad patient decision aid called Mobile Patient Technology for Health-CRC (mPATH-CRC) doubled the proportion of patients who completed CRC screening. Methods:All data for the present analysis was collected as part of a randomized-controlled trial to determine the impact of mPATH-CRC on receipt of CRC screening within 24 weeks. Participants were enrolled from 6 community-based primary care practices between June 2014 and May 2016 and randomized to either usual care or mPATH-CRC. Six potential mediators of the intervention effect on screening were considered. The Iacobucci method was used to assess the significance of the mediation. Results:A total of 408 patients had complete data for all potential mediators. Overall, the potential mediators accounted for approximately three-fourths (76.3%) of the effect of the program on screening completion. Perceived benefits, self-efficacy, ability to state a screening decision, and patient/provider discussion were statistically significant mediators. Patient/provider discussion accounted for the largest proportion of the effect of mPATH-CRC (70.7%). Conclusions: mPATH-CRC increased completion of CRC screening by affecting patient-level and system-level mediators. However, the most powerful mediator was the occurrence of a patient-provider discussion about screening. Digital interventions like mPATH-CRC are an important adjunct to the patient/provider encounter. Impact:Understanding the factors that mediated mPATH-CRC's success is paramount to developing other effective interventions.