Patient-facing web platform helped identify those with higher colorectal cancer risk

A program that asked patients to enter their family health history identified more high-risk patients but didn't change rates of colorectal cancer screening or genetic counseling, a trial of U.S. veterans found.

Having patients enter their family health history into a web-based platform may help identify those at high risk for colorectal cancer (CRC), a study found.

The trial was conducted at two Veterans Health Administration primary care practices in the U.S. and included patients who were ages 40 to 64 years and had no medical conditions that increased their CRC risk. Two hundred fifty-two patients were randomized to enter their family health history into a web-based platform that provided risk assessment and guideline-driven decision support (immediate group), while the 253 patients in the control group used the platform a year later. Results were published by the Journal of General Internal Medicine on Oct. 28.

Use of the platform increased the percentage of patients who were identified as being at increased risk for CRC, compared to how many were marked as such in the electronic medical record (9.9% vs. 5.2%; difference, 4.8% [95% CI, 2.6% to 6.9%]; P<0.0001). However, for the primary outcome of whether the primary care clinician took action in accordance with the patient's CRC risk (e.g., colonoscopy and/or genetic counseling referral), there was no difference between groups (86.9% in the immediate group vs. 91.7% in controls; odds ratio [OR], 0.7; P=0.16). There was also no difference in completion of screening among patients who had a risk-concordant screening test ordered. Of 50 patients identified by the platform as high risk, 78.6% in the immediate group and 68.2% in the control group received a recommendation for genetic consultation, but only one in each group got a referral.

The study authors concluded that tools such as this one “could accurately assess and document the clinical needs of patients at increased risk for CRC,” which could be important given that “available endoscopic resources are suspected to be insufficient for screening average-risk patients.” They speculated that the lack of difference between groups in risk-concordant care could be due to the lower-than-expected number of high-risk patients identified (possibly because so many were excluded). They noted that the rarity of genetic counseling referrals could be due to the studied facilities not having in-house genetic counselors.