A study explored text messaging to better support decision making in colorectal cancer screening among historically marginalized patient groups.
As more healthcare resources are moved to online platforms, such as patient portals, the process of shared decision making (SDM) may become impeded for some patients. Since SDM is vital to the ethical engagement of patients and healthcare providers, novel approaches to spur communication are being explored. Among these is the use of text messages to help engage patients, specifically those who have been historically marginalized.
Jennifer Elston Lafata, PhD, and colleagues developed a text message platform that educates patients about SDM in colorectal cancer screening. The texts explain who is a candidate for colorectal cancer screening, the different testing options available, and the advantages and disadvantages of these options. The research team surveyed 289 study participants while using the platform and afterward to assess their engagement with and acceptability of the platform, as well as their interest and willingness to use similar platforms.
Dr. Lafata and colleagues published the results of their study in the Journal of Medical Internet Research Cancer. Dr. Lafata discussed the findings of this work with Physician’s Weekly.
PW: Why is it important to examine the connection between text messaging and SDM of colorectal cancer screening?
Dr. Lafata: We wanted to explore the acceptability of text messaging to support the different steps of SDM for two reasons. First, because of the importance of SDM, we wanted to help people work with their doctors to decide what is best for them when they face a crossroads in their medical care. Second, because we, and others, have observed racial and other disparities in how online patient portals are used, we felt it was important to help healthcare organizations, many of which are increasingly using online patient portals, to find alternative ways to communicate with their patients about important healthcare topics, including colorectal cancer screening.
What are the most important findings from your study?
Among patients who have been marginalized due to racism, low income, or low health literacy, the use of text messaging, rather than online patient portals, may better help patients learn that they face a choice regarding their healthcare. In this study, that meant text messages could be a good way to help people learn that there are multiple ways to be screened for colorectal cancer.
The study assessed the number of participants who engaged with the text message program long enough to receive information about multiple ways to be screened for colorectal cancer (choice awareness) and about the pros and cons of at least one screening modality (option awareness). You found no significant differences in either measure by the participants’ race, health literacy, or screening history (Table). How can these findings be incorporated into practice?
Helping people understand that they face a choice regarding the next steps in their healthcare is an important component of SDM. The findings from our study show that simple text messages may help healthcare organizations and others reach broader populations than they could by relying solely on online patient portals.
What still needs to be explored regarding this topic?
As healthcare decisions become more complex, it is going to be even more important that we learn how to support and engage people in their care. Identifying the best ways to share information with and engage diverse patient populations is an important area of study.
Is there anything else that you feel Physician’s Weekly readers would benefit from knowing about your research?
Our research is focused on understanding ways to adopt SDM in practice. We think an important way to do this is to think about SDM as a process that unfolds over time between patients and members of their healthcare team—both at the time of a doctor’s office visit and in between office visits. In addition to testing ways to implement the steps along the SDM journey, we are also developing ways to measure those steps.
