Effect of Personalized Risk Messages on Patient Intent and Decision Making in Colorectal Cancer Screening: A Randomized Controlled Trial.

In 30 seconds

This randomized controlled trial evaluated whether personalized information about current advanced colorectal neoplasia (ACN) risk changed screening decisions among average-risk patients aged 50 to 75 years who were due for colorectal cancer screening. Among 1,084 patients, those shown a personalized-risk decision aid had higher odds of intending any screening (OR = 1.55, CI = 1.03, 2.33) and stool testing (OR = 2.17, CI = 1.62, 2.91), and lower odds of intending colonoscopy (OR = 0.58, CI = 0.43, 0.79), compared with those shown a generic aid. Neither intervention significantly affected informed concordance overall.

Key findings

• Personalized-risk decision aid recipients had higher odds of intending any screening (OR = 1.55, CI = 1.03, 2.33).
• Intent to have a stool test was higher (OR = 2.17, CI = 1.62, 2.91), while intent to undergo colonoscopy was lower (OR = 0.58, CI = 0.43, 0.79).
• Neither patient-facing nor provider-facing personalized risk information significantly affected informed concordance overall; a provider-message effect was observed in one health system.

Why it matters

Screening decisions involve multiple test options, and personalized risk information may influence which option patients intend to choose. The findings suggest that such messages can shift stated preferences toward stool testing and away from colonoscopy, while not demonstrating an overall improvement in informed concordance. This distinction matters when evaluating decision aids: changes in intent do not necessarily indicate better alignment between informed preferences and screening received.

What to keep in mind

The study was conducted in a single Midwestern city, included English-speaking patients only, and enrolled few patients at high-average risk for ACN.