Automated Colorectal Cancer Educational Support System (ACCESS): Development and Validation of a Novel Online Decision Aid for Improving Colorectal Cancer Screening Uptake

PROJECT SUMMARY
This proposal aims to improve colorectal cancer (CRC) screening uptake by developing and validating a novel
online decision aid called the Automated Colorectal Cancer Educational Support System (ACCESS). While CRC
is preventable, it still remains a major public health issue, as it is the third most prevalent and deadly malignancy
in the U.S. The U.S. Preventive Services Task Force (USPSTF) recommends that all Americans at average risk
for CRC undergo screening starting at age 50, yet one-third of Americans are unscreened. Eliciting patient
preferences by engaging in shared decision making via decision aids has been proposed as a potentially
effective strategy to improve screening rates. CRC screening is ideally suited for a shared decision making
approach, as the USPSTF endorses 7 different testing options (e.g., stool-, imaging-, and endoscopy-based
tests), each with distinct advantages and disadvantages. Of the few existing CRC screening decision tools, most
were ineffective as they were beset by imprecise assessment of patients’ preferences and ineffective integration
in clinical workflows. This proposal will address these gaps by creating an online, efficient, conjoint analysis-
based decision aid called ACCESS that generates a personalized report that rank orders the importance of each
test attribute (e.g., accuracy, invasiveness, etc.) in patients’ decision making. The report will also be shared with
their clinicians via the electronic health record so that they can efficiently recognize their patients’ priorities when
selecting a screening test. The hypothesis is that use of ACCESS, through optimizing shared decision making,
will lead to selection of a modality that accurately matches each patient’s unique values, and as a result, increase
screening uptake. To test this hypothesis, the proposal will achieve the following aims: (1) Gain insights into
patients’ knowledge, attitudes, beliefs, and drivers of decision making when selecting among the different
screening options through conjoint analysis, a quantitative technique that assesses how individuals make
tradeoffs; (2) Build the ACCESS decision aid in partnership with patients, clinicians, implementation and
behavioral science experts, and computer scientists; (3) Conduct a pilot randomized controlled trial to determine
if ACCESS improves CRC screening uptake vs. usual care. To successfully complete the project, the PI will
receive mentorship from experienced clinicians, health services researchers, implementation and behavioral
scientists, and digital health experts. The PI will also address his knowledge gaps by taking formal coursework
in implementation and behavioral sciences, conjoint choice modeling, qualitative analysis, quality measurement
and improvement, and trial design. He will also participate in R grant writing workshops over the award period.
Obtaining these competencies combined with successful completion of the study will allow him to work towards
his goal of becoming an independent, NIH-funded digital health scientist focused on enhancing cancer
prevention and health promotion through the user-centered development and use of innovative, scalable,
evidence-based technologies that support patients and clinicians in making shared decisions.

Grant Number: 5K08CA245033-05
NIH Institute/Center: NIH
Principal Investigator: Christopher Almario