Impact of Family History and Decision Support on High-risk Cancer Screening

Family health history can help identify patients at higher than average risk for disease. There is no standardized system for collecting and updating family health history, using this information to determine a patient's disease risk level, and providing screening recommendations to patients and providers. Patients will enter their family health history into MeTree, a family history software program. The program will produce screening recommendations tailored to the patient's family health history. The investigators will examine whether this process increases physician referrals for, and patient uptake of, guideline-recommended screening for colorectal cancer.

Sex

All

Minimum age

40 Years

Maximum age

64 Years

Inclusion Criteria:

Primary care provider inclusion criteria:

* primary care physician,
* physician assistant, or nurse practitioner;
* at least one half-day of primary care clinic per week.

Patient inclusion criteria:

* assigned to an enrolled PCP;
* English as preferred language;
* no plans to relocate or leave the VA system in the next 12 months;
* at least one primary care appointment in the 18 months prior to enrollment;
* upcoming PCP appointment with assigned PCP;
* aged 40-64 years; no previous history of colorectal cancer or adenomatous polyps or inflammatory bowel disease;
* no endoscopy within previous 3 years; some knowledge of family health history

Exclusion Criteria:

n/a (contained within inclusion criteria)

• RESULTGoldstein KM, Fisher DA, Wu RR, Orlando LA, Coffman CJ, Grubber JM, Rakhra-Burris T, Wang V, Scheuner MT, Sperber N, Datta SK, Nelson RE, Strawbridge E, Provenzale D, Hauser ER, Voils CI. An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial. Trials. 2019 Oct 7;20(1):576. doi: 10.1186/s13063-019-3659-y. PMID 31590688
• DERIVEDVoils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, Sperber N, Wang V, Scheuner MT, Provenzale D, Nelson RE, Hauser E, Orlando LA, Goldstein KM. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med. 2023 May;38(6):1375-1383. doi: 10.1007/s11606-022-07787-9. Epub 2022 Oct 28. PMID 36307642