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Implementing a Colorectal Cancer Screening Decision Aid via Text Messaging in a Large Massachusetts Health Care
Kim Ariyabuddhiphongs1, Timothy Carey1, Emily A Wolfson1
1Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
MDM Policy & Practice
|March 9, 2026
Summary
Implementing colorectal cancer (CRC) screening decision aids (DAs) via text message improved patient knowledge and shared decision-making quality. However, a more intensive strategy is needed to increase patient engagement with these important CRC screening tools.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Digital Health Implementation
Background:
- Colorectal cancer (CRC) screening decision aids (DAs) enhance patient understanding and involvement in screening decisions.
- A quality improvement initiative utilized the Theory of Change framework to implement a CRC DA within a Boston-area health system.
Purpose of the Study:
- To implement and evaluate the impact of a text-message-delivered CRC screening DA on patient knowledge, shared decision-making (SDM) quality, and discussions with primary care providers (PCPs).
Main Methods:
- A 2-page, smartphone-readable CRC screening DA was developed for adults aged 45-75.
- Patients due for CRC screening received the DA via text message before their PCP appointments.
- Linear regression analyzed the DA's effect on SDM quality, knowledge, and reported discussions of screening modalities.
Main Results:
- Patients who reviewed the texted CRC screening DA reported higher SDM quality (2.5 vs. 2.1) and increased knowledge compared to baseline.
- Reviewing the DA was associated with a higher likelihood of discussing stool-based CRC screening with PCPs.
- A low response rate (5.6%) was observed for the study surveys.
Conclusions:
- Automated text messaging of CRC screening DAs is feasible for large health systems.
- Texted CRC screening DAs can improve SDM quality and patient knowledge.
- Enhanced implementation strategies are necessary to improve patient review rates of DAs.
