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iPad app doubles colorectal cancer screening rates

A digital health intervention including an iPad app that educated patients on colorectal cancer screening options and allowed them to order their preferred test increased screening rates by twofold, according to a study published in Annals of Internal Medicine.

“Screening for colorectal cancer reduces mortality, yet more than one-third of age-eligible Americans are unscreened,” David P. Miller Jr., MD, MS, from Wake Forest School of Medicine, and colleagues wrote.

Miller and colleagues conducted a randomized clinical trial to determine whether a digital health intervention known as Mobile Patient Technology for Health-CRC (mPATH-CRC) improves colorectal cancer screening rates. The researchers enrolled 450 patients who were being seen at one of six community-based primary care practices and were due for routine colorectal cancer screening.

Participants were randomly assigned to the digital health intervention group (n = 223) or usual care group (n = 227). Those in the digital health intervention group used the mPATH-CRC iPad app, which served as a colorectal cancer screening decision aid and educated patients on different types of screening tests, allowed them to order tests and supported them with automated follow-up messages.

There were similar baseline characteristics between both groups. Limited health literacy was demonstrated by 37% of participants. Slightly more than half (53%) of participants had annual incomes less than $20,000.

More patients in the mPATH-CRC group completed screening than those in the usual care group (30% vs. 15%; OR = 2.5; 95% CI, 1.6-4). Participants in the mPATH-CRC group were more likely to have a screening preference, plan to be screened within 6 months, discuss screening with a health care provider and order a screening test. More than half (53%) of mPATH-CRC participants ordered a screening test on their own using the app.

“mPATH-CRC doubled the proportion of patients who completed [colorectal cancer] screening,” Miller and colleagues concluded. “Although screening increased substantially in this study that included many persons with low income and limited health literacy, approximately half of patients did not complete their ordered tests. Incorporating more strategies to help patients complete their tests could further increase the effectiveness of mPATH-CRC. Future research should identify methods for implementing digital health interventions like mPATH-CRC into clinical care.”

In an accompanying editorial, Shivan J. Mehta, MD, MBA, MSHP, and David A. Asch, MD, MBA, both from the Center for Health Care Innovation at the University of Pennsylvania, warn that the results may not translate to a broader population because participants were limited to those who already agreed to participate in the research.

“Given efforts so far, most improvements in [colorectal cancer] screening will probably arrive incrementally from compound interventions,” they wrote. “Seeking the active ingredients of these compounds is natural. Sometimes they will be found in technology, sometimes in education, and sometimes in behavior. But the active ingredients of transformative change are likely to come from new ways to engage with patients outside of office visits and other traditional processes of care and new ways to evaluate these approaches faster and with greater validity.” – by Alaina Tedesco

Disclosure: Miller reports receiving grants from the National Cancer Institute and the National Institutes of Health. Please see study for all other authors’ relevant financial disclosures. Mehta reports no relevant financial disclosures. Asch reports receiving personal fees and other support from VAL Health.