1. Ca ncer Scr ee ni ng A dh er en ce th r ou gh Te ch no lo gy -e nh a nced Sh a r ed De cis io n M a k in g (C SA TS )
M a s a h ito J im b o 1 , M a ck R u ffin 1 , Do n a ld N e a s e 1 , M ich a e l Fe tte r s 1 , V icto r S tr e ch e r 2 , Ed w a r d S a u n d e r s 2
1 : U n iv e r s ity o f M ich ig a n De p a r tm e n t o f Fa m ily M e d icin e ; 2 : U n iv e r s ity o f M ich ig a n Ce n te r fo r H e a lth Co m m u n ica tio n R e s e a r ch
Co lo r e cta l W e b : Co n ce p tu a l M o d e l
Co lo r e cta l W e b
B a ck g r o u n d
Phy sicia n a nd pa tient reminder sy stems modestly Combina tion of Ela bora tion Lik elihood M odel a nd Theory of Pla nned Beha vior.
increa se colorecta l ca ncer (CRC) screening ra te. Decision 1. Ela bora tion Lik elihood M odel
a ids a nd ta ilored beha viora l interventions ha ve ha d - Centra l processing: People a re more lik ely to be persua ded if they ca n ela bora te ex tensively on a messa ge.
va ria ble success, but genera lly ha ve not been delivered - Periphera l processing: People ma y be persua ded tempora rily by fa ctors tha t ha ve nothing do w ith the a ctua l
by the pa tient's prima ry ca re phy sicia n (PCP), not content of the messa ge.
ca pita lizing on the evidence tha t phy sicia n a . Informa tion on Colorecta l W eb motiva tes the user to ela bora te a nd process centra lly .
recommenda tion cha nges pa tient beha vior. b. Intera ctive ex pla na tions a nd tools in Colorecta l W eb ena ble the user to ela bora te rela tively ea sily .
c. The intera ctive na ture of the tools ma y a lso cue the user through the periphera l route.
2. Theory of Pla nned Beha vior
O b je ctiv e - Beha vior is determined by intention to perform the beha vior.
- Intention = Attitude x Subjective norm x Perceived beha viora l control
- The theory ha s held up w ell in situa tions w here a person needs to ma k e volunta ry choices.
To develop a nd test the fea sibility of Ca ncer
Screening Adherence through Technology -enha nced
Sha red Decision M a k ing (CSATS), a beha viora l
intervention model to improve CRC screening tha t link s A ttitudes
P r efer ence Selection
the follow ing to enha nce Sha red Decision M a k ing
(SDM ) betw een the pa tient a nd the phy sicia n: Intent
P er ceiv ed
1. Colorecta l W eb: a beha viora l intervention tha t Decision A id B eha v ior a l
(Color ecta l W eb)
combines decision a id a nd risk a ssessment. Contr ol
2. ClinfoTra ck er: a computer prompt/ reminder sy stem. Infor m a tion P r ocessing
Subjectiv e
(Ela bor a tion)
3. Phy sicia n recommenda tion.
N or m
Sha r ed Decision M a k ing B eha v ior
Clarification of
COLORECTAL WEB Shared
patient risk and
Decision aid Decision
preferences O n g o in g Fe a s ib ility S tu d y
on risk Making
and
preference Setting: 2 university -a ffilia ted fa mily medicine pra ctices.
LINK
Pa tients: 20 pa tients a ged 5 0 to 74 y ea rs.
Intervention:
- Before the pla nned hea lth ma intena nce visit, consenting pa tients identified by ClinfoTra ck er a s due for CRC
ClinfoTracker screening w ill securely log in to Colorecta l W eb a nd complete the intera ctive risk a nd preference survey s.
Physician Reminder - W hen the pa tients a rrive, phy sicia ns w ill receive CRC screening reminder a nd risk / preference survey results.
(Can import data set - Phy sicia ns w ill use this informa tion to fa cilita te CRC screening discussion.
from any software) M a in a nd Seconda ry O utcome M ea sures: Q ua ntita tive a nd qua lita tive descriptive process outcomes obta ined through
Colorecta l W eb da ta retrieva l, pa tient telephone interview s, visit a udiota pes, a nd pa tient a nd phy sicia n survey s.
(Before Visit) (At Visit)
- The ea se a nd usefulness of Colorecta l W eb
- The effect of CSATS on the w ork flow of PCP pra ctices a nd the process of SDM rega rding CRC screening
- Pa tient k now ledge, a ttitide, decisiona l conflict/ sa tisfa ction, a nd a ctua l CRC screening ra te.