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Grant Details

Grant Number: 5R01CA197205-05 Interpret this number
Primary Investigator: Elston Lafata, Jennifer
Organization: Univ Of North Carolina Chapel Hill
Project Title: E-ASSIST: a Post-Visit Patient Portal Tool to Promote Colorectal Cancer Screening
Fiscal Year: 2019


 DESCRIPTION (provided by applicant): Colorectal rectal cancer (CRC) is the third most common cancer in the US with over 50,000 individuals dying annually from the disease. Despite multiple effective screening tests, CRC screening remains underutilized relative to other cancer screening. A driving factor behind this underutilization among insured populations is the gap that exists between a physician recommendation for care and the patient's receipt of screening. How best to support patients in CRC screening once they have a physician recommendation for care remains unknown. The proposed project will test the effectiveness and impact of a post-visit, patient portal tool, e-Assist, for engaging and supporting primary care patients in their decision making regarding, and ultimately in their obtaining, CRC screening. The tool purposely leverages the cue to action provided by a physician recommendation for care as well as the secure patient portal platform now commonly found within primary care practices. It seamlessly combines important patient-physician decision making content with assistance in removing personal and structural barriers to screening. Our research will answer four overarching questions: (1) Can a post-visit, patient portal tool, e-Assist, increase adherence to physician-recommended CRC screening? (2) How does e-Assist engage primary care patients in the CRC screening decision making process? (3) Are there subgroups of the primary care population for whom e-Assist is more engaging and effective? and (4) What adaptations are needed to e-Assist to improve its reach, and ensure its adoption, implementation, and ultimately its impact on evidence-based CRC screening use among diverse primary care patients and clinics? These questions will be addressed using a two-arm, practical randomized trial supplemented with findings from focus groups and in-depth interviews with patients, clinicians and other clinic staff to ensure a comprehensive understanding of not only program effectiveness and implementation, but the factors driving overall program impact. Results will illustrate how e-tools can be used following an office visit to support both patient decision making, and the dissemination and implementation of evidence-based cancer screening services in primary care.


Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial.
Authors: Elston Lafata J. , Shires D.A. , Shin Y. , Flocke S. , Resnicow K. , Johnson M. , Nixon E. , Sun X. , Hawley S. .
Source: Medical decision making : an international journal of the Society for Medical Decision Making, 2022 Nov; 42(8), p. 985-998.
EPub date: 2022-06-28.
PMID: 35762832
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How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening.
Authors: Alishahi Tabriz A. , Neslund-Dudas C. , Turner K. , Rivera M.P. , Reuland D.S. , Elston Lafata J. .
Source: Chest, 2021 Jan; 159(1), p. 413-425.
EPub date: 2020-08-13.
PMID: 32798520
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Logic model framework for considering the inputs, processes and outcomes of a healthcare organisation-research partnership.
Authors: Tabriz A.A. , Flocke S.A. , Shires D. , Dyer K.E. , Schreiber M. , Elston Lafata J. .
Source: BMJ quality & safety, 2020 Sep; 29(9), p. 746-755.
EPub date: 2019-12-11.
PMID: 31826921
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Lower Adherence: A Description of Colorectal Cancer Screening Barrier Talk.
Authors: Johnson Shen M. , Elston Lafata J. , D'Agostino T.A. , Bylund C.L. .
Source: Journal of health communication, 2020; 25(1), p. 43-53.
EPub date: 2019-12-04.
PMID: 31795843
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Challenges and opportunities using online portals to recruit diverse patients to behavioral trials.
Authors: Tabriz A.A. , Fleming P.J. , Shin Y. , Resnicow K. , Jones R.M. , Flocke S.A. , Shires D.A. , Hawley S.T. , Willens D. , Lafata J.E. .
Source: Journal of the American Medical Informatics Association : JAMIA, 2019-12-01; 26(12), p. 1637-1644.
PMID: 31532482
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Patient-Reported Needs Following a Referral for Colorectal Cancer Screening.
Authors: Dyer K.E. , Shires D.A. , Flocke S.A. , Hawley S.T. , Jones R.M. , Resnicow K. , Shin Y. , Lafata J.E. .
Source: American journal of preventive medicine, 2019 Feb; 56(2), p. 271-280.
EPub date: 2018-12-13.
PMID: 30554975
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Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening: the e-assist: Colon Health study-a protocol study.
Authors: Lafata J.E. , Shin Y. , Flocke S.A. , Hawley S.T. , Jones R.M. , Resnicow K. , Schreiber M. , Shires D.A. , Tu S.P. .
Source: BMJ open, 2019-01-07; 9(1), p. e023986.
EPub date: 2019-01-07.
PMID: 30617102
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Patients' adoption of and feature access within electronic patient portals.
Authors: Elston Lafata J. , Miller C.A. , Shires D.A. , Dyer K. , Ratliff S.M. , Schreiber M. .
Source: The American journal of managed care, 2018-11-01; 24(11), p. e352-e357.
EPub date: 2018-11-01.
PMID: 30452203
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Statistical Power in Two-Level Hierarchical Linear Models with Arbitrary Number of Factor Levels.
Authors: Shin Y. , Lafata J.E. , Cao Y. .
Source: Journal of statistical planning and inference, 2018 Mar; 194, p. 106-121.
EPub date: 2017-09-28.
PMID: 29358843
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Understanding the influences and impact of patient-clinician communication in cancer care.
Authors: Lafata J.E. , Shay L.A. , Winship J.M. .
Source: Health expectations : an international journal of public participation in health care and health policy, 2017 Dec; 20(6), p. 1385-1392.
EPub date: 2017-06-21.
PMID: 28636108
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Primary Care Physicians' Support of Shared Decision Making for Different Cancer Screening Decisions.
Authors: Elston Lafata J. , Brown R.F. , Pignone M.P. , Ratliff S. , Shay L.A. .
Source: Medical decision making : an international journal of the Society for Medical Decision Making, 2017 Jan; 37(1), p. 70-78.
EPub date: 2016-07-18.
PMID: 27430237
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