case study

Cancer Screening


FUNDED BY: Centers for Disease Control and Prevention

PROBLEM: Colorectal cancer is the second leading cause of death due to cancers that affect both men and women (after lung cancer). Colorectal cancer screening saves lives because it is effective at identifying early stages of this slow-growing cancer when it is most easily treated. However, national screening rates are very low, and even lower among certain demographic groups including African Americans, American Indians, and Alaskan Natives. Moreover, the screening guidelines can be complex, given a patient’s risk factors and results from previous screenings.

APPROACH: Applied Decision Science led an effort to understand and directly address the underlying challenges and barriers to timely colorectal cancer screening, both from the patient and the provider perspective. We conducted a cognitive task analysis (CTA) of primary care providers to help us identify the key barriers to screening. We then developed a series of prototypes using decision-centered design and agile software development and conducted user feedback testing with health informaticists and subject matter experts. Finally, we conducted a series of evaluation studies with representative users to determine the usefulness of the prototype over existing tools and methods to track colorectal cancer screening.

IMPACT: We developed an innovative, time-based visualization that presents a patient’s screening history and test findings next to CDC screening guidelines that are relevant to the patient’s individualized risk profile. Additionally, we developed easy-to-read, 1-page brochures targeted to different risk populations (e.g., American Indians, Alaskan Natives, African Americans) that providers can use to talk to their patients about their individual risk level and screening options. Results of our large-scale evaluation showed that providers found the Screening & Surveillance App both usable and useful.

Militello, L.G., Diiulio, J.B., Borders, M.R., Sushereba, C.E., Saleem, J.J., Haverkamp D, Imperiale, T.F. (2017) Evaluating a modular decision support application for colorectal cancer screening. Applied Clinical Informatics, 8(1).
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Militello, L.G., Saleem. J.J., Borders, M.R., Sushereba, C.E., Haverkamp, D., Wolf, S.P., Doebbeling, B.N. (2016). Designing Colorectal Cancer Screening Decision Support: A cognitive engineering enterprise. Journal of Cognitive Engineering and Decision Making, 10(1), pp. 74-90.
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