• David P Miller, Nancy Denizard-Thompson, Kathryn E Weaver, L Doug Case, Jennifer L Troyer, John G Spangler, Donna Lawler, and Michael P Pignone.
• Wake Forest School of Medicine, Winston-Salem, North Carolina (D.P.M., N.D., K.E.W., L.D.C., J.G.S., D.L.).
• Ann. Intern. Med. 2018 Apr 17; 168 (8): 550-557.

BackgroundScreening for colorectal cancer (CRC) reduces mortality, yet more than one third of age-eligible Americans are unscreened.ObjectiveTo examine the effect of a digital health intervention, Mobile Patient Technology for Health-CRC (mPATH-CRC), on rates of CRC screening.DesignRandomized clinical trial. (ClinicalTrials.gov: NCT02088333).Setting6 community-based primary care practices.Participants450 patients (223 in the mPATH-CRC group and 227 in usual care) scheduled for a primary care visit and due for routine CRC screening.InterventionAn iPad application that displays a CRC screening decision aid, lets patients order their own screening tests, and sends automated follow-up electronic messages to support patients.MeasurementsThe primary outcome was chart-verified completion of CRC screening within 24 weeks. Secondary outcomes were ability to state a screening preference, intention to receive screening, screening discussions, and orders for screening tests. All outcome assessors were blinded to randomization.ResultsBaseline characteristics were similar between groups; 37% of participants had limited health literacy, and 53% had annual incomes less than $20 000. Screening was completed by 30% of mPATH-CRC participants and 15% of those receiving usual care (logistic regression odds ratio, 2.5 [95% CI, 1.6 to 4.0]). Compared with usual care, more mPATH-CRC participants could state a screening preference, planned to be screened within 6 months, discussed screening with their provider, and had a screening test ordered. Half of mPATH-CRC participants (53%; 118 of 223) "self-ordered" a test via the program.LimitationParticipants were English speakers in a single health care system.ConclusionA digital health intervention that allows patients to self-order tests can increase CRC screening. Future research should identify methods for implementing similar interventions in clinical care.Primary Funding SourceNational Cancer Institute.

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