Implementing a Colorectal Cancer Screening Decision Aid via Text Messaging in a Large Massachusetts Health Care...

Background. The use of colorectal cancer (CRC) screening decision aids (DAs) increases patient knowledge and engagement in decision making. Thus, we aimed to implement a CRC DA in a Boston-area health system informed by the Theory of Change quality improvement framework. Methods. Following international standards, an interdisciplinary working group developed a 2-page CRC screening DA, readable on smartphones, for adults ages 45 to 75 y. Prior to DA implementation, we texted a study survey to 8,641 adults age 45 to 75 y seen in primary care at our health system (baseline). Between January 2022 and April 2023, we texted the DA to 21,522 patients due for CRC screening and scheduled with their primary care provider (PCP). In August 2022 and in May 2023 (follow-up), we texted a study survey to patients who had been texted the DA in prior months. We used linear regression to examine the DA's effects on shared decision-making (SDM) quality (using the 4-item SDM Process Scale, for which scores range from 0-4), knowledge (2 questions), and reported discussions with PCPs of screening modalities. Results. Of 30,163 texted study surveys, 1,692 (5.6%, 697 baseline and 995 follow-up) were completed; 77.1% of participants were non-Hispanic White and 45.3% were aged 60 to 75 y. Overall, 30.6% (n = 304) of follow-up survey respondents reported reviewing the DA. Compared with baseline participants, these patients reported higher SDM quality (SDM process scores = 2.5 v. 2.1, P < 0.001) and more knowledge about CRC screening and were more likely to have discussed stool-based testing with PCPs. Limitations. Low response rate with no sociodemographic data for nonresponders. Conclusions/Implications. Patients who read a CRC screening DA texted to them before primary care visits may experience improved SDM quality. However, a more intensive implementation strategy may be needed for more patients to read DAs.

It is feasible for large health systems to automatize text messaging of colorectal cancer (CRC) screening decision aids (DAs) to patients due for CRC screening before a visit with their primary care practitioner.Patients who review a texted CRC screening DA report higher shared decision-making quality and knowledge about CRC screening.Use of CRC DAs may decrease screening via colonoscopy but not overall screening rates.A more intensive intervention than text messaging is likely needed to increase the number of patients who review a CRC screening DA.