Effectiveness and Implementation of mPATH-CRC

NCT ID: NCT03843957

Last Updated: 2024-01-31

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

77145 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-31

Study Completion Date

2023-03-10

Brief Summary

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Study Investigators are conducting this study to learn how to best implement a new iPad program in clinical practice.

Detailed Description

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The study team has developed mPATH-CRC (mobile PAtient Technology for Health-Colorectal Cancer), a patient-friendly iPad program used by individuals immediately before a routine primary care visit. mPATH-CheckIn is a module that is used in conjunction with mPATH-CRC that consists of questions asked of all adult patients at check-in. mPATH-CRC is a module specific for patients due for CRC screening.

To fully realize mPATH-CRC's potential to decrease CRC mortality, the program now must be implemented in primary care practices in a way that encourages routine and sustained use. However, while hundreds of mobile health (mHealth) tools have been developed in recent years, the optimal strategies for implementing and maintaining mHealth interventions in clinical practice are unknown. This study will compare the results of a "high touch" strategy to a "low touch" strategy using a Type III hybrid design and incorporating mixed methods to evaluate implementation, maintenance, and effectiveness of mPATH-CRC in a diverse sample of community-based practices.

The study will be conducted in three phases: 1) in a cluster-randomized controlled trial of 22 primary care clinics, the study team will compare the implementation outcomes of a "high touch" evidence-based mHealth implementation strategy with a "low touch" implementation strategy; 2) in a nested pragmatic study, the study team will estimate the effect of mPATH-CRC on completion of CRC screening within 16 weeks of a clinic visit; and 3) by surveying and interviewing clinic staff and providers after implementation is complete, the study team will determine the factors that facilitate or impede the maintenance of mHealth interventions.

Conditions

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Colorectal Cancer Cancer Rectum Cancer Colon Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Clinic Patients Eligible for CRC Screening on "high touch" Strategy (Post-Implementation)

English or Spanish-speaking patients aged 50-74 who are eligible for CRC screening who are seen in the study clinics randomized to mPATH utilizing the "high touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-CRC

Intervention Type OTHER

mPATH-CRC is a self-administered iPad program that patients eligible for CRC screening use in primary care clinics to help them receive CRC screening.

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"high touch" Implementation strategy

Intervention Type OTHER

The "high touch" strategy consists of pre-implementation activities, training, and ongoing support.

Pre-Implementation Activities

* Clinic champion identified.
* Study team meeting with clinic champion
* Implementation adaptations as needed for clinic flow

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard
* Monthly program usage report sent to clinic champions
* Scheduled phone-calls with clinic champion to review QA data and explore potential barriers.
* Implementation adaptations as needed for clinic flow
* Goal-triggered follow-up on-site trainings
* Additional on-site trainings as requested.

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Clinic Patients Eligible for CRC Screening on "low touch" Strategy (Post-Implementation)

English or Spanish-speaking patients aged 50-74 who are eligible for CRC screening who are seen in the study clinics randomized to mPATH utilizing the "low touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-CRC

Intervention Type OTHER

mPATH-CRC is a self-administered iPad program that patients eligible for CRC screening use in primary care clinics to help them receive CRC screening.

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"low touch" Implementation Strategy

Intervention Type OTHER

Clinics randomized to receive the low touch implementation strategy will receive:

Pre-Implementation Activities

• N/A

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Clinic personnel on "high touch" Strategy (Post-Implementation)

Clinic personnel (e.g., administrators, nurses, providers) who are involved with the implementation of mPATH-CRC, in the study clinics randomized to mPATH utilizing the "high touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-CRC

Intervention Type OTHER

mPATH-CRC is a self-administered iPad program that patients eligible for CRC screening use in primary care clinics to help them receive CRC screening.

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"high touch" Implementation strategy

Intervention Type OTHER

The "high touch" strategy consists of pre-implementation activities, training, and ongoing support.

Pre-Implementation Activities

* Clinic champion identified.
* Study team meeting with clinic champion
* Implementation adaptations as needed for clinic flow

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard
* Monthly program usage report sent to clinic champions
* Scheduled phone-calls with clinic champion to review QA data and explore potential barriers.
* Implementation adaptations as needed for clinic flow
* Goal-triggered follow-up on-site trainings
* Additional on-site trainings as requested.

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Clinic personnel on "low touch" Strategy (Post-Implementation)

Clinic personnel (e.g., administrators, nurses, providers) who are involved with the implementation of mPATH-CRC, in the study clinics randomized to mPATH utilizing the "low touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-CRC

Intervention Type OTHER

mPATH-CRC is a self-administered iPad program that patients eligible for CRC screening use in primary care clinics to help them receive CRC screening.

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"low touch" Implementation Strategy

Intervention Type OTHER

Clinics randomized to receive the low touch implementation strategy will receive:

Pre-Implementation Activities

• N/A

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

All Adult Clinic Patients on "high touch" Strategy (Post-Implementation)

English or Spanish-speaking patients aged 18 or older who are seen in the study clinics randomized to mPATH utilizing the "high touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"high touch" Implementation strategy

Intervention Type OTHER

The "high touch" strategy consists of pre-implementation activities, training, and ongoing support.

Pre-Implementation Activities

* Clinic champion identified.
* Study team meeting with clinic champion
* Implementation adaptations as needed for clinic flow

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard
* Monthly program usage report sent to clinic champions
* Scheduled phone-calls with clinic champion to review QA data and explore potential barriers.
* Implementation adaptations as needed for clinic flow
* Goal-triggered follow-up on-site trainings
* Additional on-site trainings as requested.

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

All Adult Clinic Patients on "low touch" Strategy (Post-Implementation)

English or Spanish-speaking patients aged 18 or older who are seen in the study clinics randomized to mPATH utilizing the "low touch" implementation strategy in the 12 months after implementation.

Group Type EXPERIMENTAL

mPATH-Checkin

Intervention Type OTHER

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

"low touch" Implementation Strategy

Intervention Type OTHER

Clinics randomized to receive the low touch implementation strategy will receive:

Pre-Implementation Activities

• N/A

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Clinic Patients Eligible for CRC Screening on "high touch" Strategy (Pre-Implementation)

English or Spanish-speaking patients aged 50-74 who are eligible for CRC screening who are seen in the study clinics randomized to mPATH utilizing the "high touch" implementation strategy but in 8 months before implementation.

Group Type OTHER

"high touch" Implementation strategy

Intervention Type OTHER

The "high touch" strategy consists of pre-implementation activities, training, and ongoing support.

Pre-Implementation Activities

* Clinic champion identified.
* Study team meeting with clinic champion
* Implementation adaptations as needed for clinic flow

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard
* Monthly program usage report sent to clinic champions
* Scheduled phone-calls with clinic champion to review QA data and explore potential barriers.
* Implementation adaptations as needed for clinic flow
* Goal-triggered follow-up on-site trainings
* Additional on-site trainings as requested.

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Clinic Patients Eligible for CRC Screening on "low touch" Strategy (Pre-Implementation)

English or Spanish-speaking patients aged 50-74 who are eligible for CRC screening who are seen in the study clinics randomized to mPATH utilizing the "low touch" implementation strategy but in 8 months before implementation.

Group Type OTHER

"low touch" Implementation Strategy

Intervention Type OTHER

Clinics randomized to receive the low touch implementation strategy will receive:

Pre-Implementation Activities

• N/A

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Interventions

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mPATH-CRC

mPATH-CRC is a self-administered iPad program that patients eligible for CRC screening use in primary care clinics to help them receive CRC screening.

Intervention Type OTHER

mPATH-Checkin

The mPATH-CheckIn program includes health questions to assist clinics with patient check-in, thereby incentivizing its use for all patients.

Intervention Type OTHER

"high touch" Implementation strategy

The "high touch" strategy consists of pre-implementation activities, training, and ongoing support.

Pre-Implementation Activities

* Clinic champion identified.
* Study team meeting with clinic champion
* Implementation adaptations as needed for clinic flow

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard
* Monthly program usage report sent to clinic champions
* Scheduled phone-calls with clinic champion to review QA data and explore potential barriers.
* Implementation adaptations as needed for clinic flow
* Goal-triggered follow-up on-site trainings
* Additional on-site trainings as requested.

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Intervention Type OTHER

"low touch" Implementation Strategy

Clinics randomized to receive the low touch implementation strategy will receive:

Pre-Implementation Activities

• N/A

Implementation Kick-Off (Day 1)

• On-site training with key clinic personnel

Months 1 - 6

* Phone/email technical support, as needed.
* Access to web-based QA dashboard

Months 7 - 12

* Phone/email technical support, as needed
* Access to web-based QA dashboard

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Due for routine CRC screening, defined as:

* No colonoscopy within the prior 10 years
* No flexible sigmoidoscopy within the prior 5 years
* No CT colonography within the prior 5 years
* No fecal DNA testing within the prior 3 years
* No fecal blood testing (guaiac-based test with home kit or fecal immunochemical test) within the prior 12 months

Exclusion Criteria

* Personal history of CRC
* First degree relative with CRC
* Personal history of colorectal polyps
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David Miller, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Site Status

Countries

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United States

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Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

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Document Type: Informed Consent Form

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Related Links

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http://eric.ed.gov/?id=ED493284

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Behavioral Risk Factor Surveillance System, 2015 Questionnaire \[Internet\]. Centers for Disease Control and Prevention (US); 2014 \[cited 2016 Sep 30\].

Other Identifiers

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R01CA218416

Identifier Type: NIH

Identifier Source: secondary_id

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IRB00048919

Identifier Type: -

Identifier Source: org_study_id

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