Trial Outcomes & Findings for Helping Patients and Providers Make Better Decisions About Colorectal Cancer Screening (NCT NCT04683731)

Last Updated: 2024-12-13

Results Overview

Patients' completion of colonoscopy, fecal immunochemical testing (FIT), or other CRC screening within 6 months, based on documentation in the participants' electronic health record.

Recruitment status

COMPLETED

Study phase

Target enrollment

1111 participants

Primary outcome timeframe

6 months after patient enrollment

Results posted on

2024-12-13

Participant Flow

Patients were recruited from primary care practices between January 2021 and November 2022.

Participant milestones

Participant milestones
Measure	Group 1 Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 2 Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, advanced colorectal neoplasm (ACN) risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Overall Study STARTED	294	265	262	290
Overall Study COMPLETED	290	262	247	285
Overall Study NOT COMPLETED	4	3	15	5

Reasons for withdrawal

Reasons for withdrawal
Measure	Group 1 Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 2 Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, advanced colorectal neoplasm (ACN) risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Overall Study Withdrawal by Subject	1	0	3	2
Overall Study Determined patient was not eligible	3	3	12	3

Baseline Characteristics

Helping Patients and Providers Make Better Decisions About Colorectal Cancer Screening

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Total n=1084 Participants Total of all reporting groups
Age, Continuous	56.2 years STANDARD_DEVIATION 5.9 • n=93 Participants	56.8 years STANDARD_DEVIATION 6.5 • n=4 Participants	56.5 years STANDARD_DEVIATION 6.2 • n=27 Participants	56.4 years STANDARD_DEVIATION 6.2 • n=483 Participants	56.5 years STANDARD_DEVIATION 6.2 • n=36 Participants
Sex: Female, Male Female	173 Participants n=93 Participants	155 Participants n=4 Participants	140 Participants n=27 Participants	179 Participants n=483 Participants	647 Participants n=36 Participants
Sex: Female, Male Male	117 Participants n=93 Participants	107 Participants n=4 Participants	107 Participants n=27 Participants	106 Participants n=483 Participants	437 Participants n=36 Participants
Race/Ethnicity, Customized Consolidated Race · Black	76 Participants n=93 Participants	63 Participants n=4 Participants	74 Participants n=27 Participants	77 Participants n=483 Participants	290 Participants n=36 Participants
Race/Ethnicity, Customized Consolidated Race · Hispanic	13 Participants n=93 Participants	7 Participants n=4 Participants	8 Participants n=27 Participants	6 Participants n=483 Participants	34 Participants n=36 Participants
Race/Ethnicity, Customized Consolidated Race · Other	17 Participants n=93 Participants	15 Participants n=4 Participants	8 Participants n=27 Participants	13 Participants n=483 Participants	53 Participants n=36 Participants
Race/Ethnicity, Customized Consolidated Race · White	171 Participants n=93 Participants	165 Participants n=4 Participants	148 Participants n=27 Participants	180 Participants n=483 Participants	664 Participants n=36 Participants
Race/Ethnicity, Customized Consolidated Race · Unknown or Not Reported	13 Participants n=93 Participants	12 Participants n=4 Participants	9 Participants n=27 Participants	9 Participants n=483 Participants	43 Participants n=36 Participants
Region of Enrollment United States	290 participants n=93 Participants	262 participants n=4 Participants	247 participants n=27 Participants	285 participants n=483 Participants	1084 participants n=36 Participants
Education - highest level Less than high school	9 Participants n=93 Participants	16 Participants n=4 Participants	10 Participants n=27 Participants	10 Participants n=483 Participants	45 Participants n=36 Participants
Education - highest level High school graduate/GED	45 Participants n=93 Participants	54 Participants n=4 Participants	55 Participants n=27 Participants	55 Participants n=483 Participants	209 Participants n=36 Participants
Education - highest level Some college or technical school/trade school	79 Participants n=93 Participants	67 Participants n=4 Participants	59 Participants n=27 Participants	68 Participants n=483 Participants	273 Participants n=36 Participants
Education - highest level Associates degree	28 Participants n=93 Participants	32 Participants n=4 Participants	24 Participants n=27 Participants	26 Participants n=483 Participants	110 Participants n=36 Participants
Education - highest level Bachelors degree	69 Participants n=93 Participants	42 Participants n=4 Participants	53 Participants n=27 Participants	68 Participants n=483 Participants	232 Participants n=36 Participants
Education - highest level Professional or graduate degree	38 Participants n=93 Participants	33 Participants n=4 Participants	29 Participants n=27 Participants	45 Participants n=483 Participants	145 Participants n=36 Participants
Education - highest level Prefer not to answer	9 Participants n=93 Participants	6 Participants n=4 Participants	6 Participants n=27 Participants	5 Participants n=483 Participants	26 Participants n=36 Participants
Education - highest level Unknown or Not Reported	13 Participants n=93 Participants	12 Participants n=4 Participants	11 Participants n=27 Participants	8 Participants n=483 Participants	44 Participants n=36 Participants
Relationship Divorced	69 Participants n=93 Participants	46 Participants n=4 Participants	54 Participants n=27 Participants	62 Participants n=483 Participants	231 Participants n=36 Participants
Relationship Married or living with a partner	140 Participants n=93 Participants	141 Participants n=4 Participants	128 Participants n=27 Participants	144 Participants n=483 Participants	553 Participants n=36 Participants
Relationship Never married	43 Participants n=93 Participants	43 Participants n=4 Participants	40 Participants n=27 Participants	43 Participants n=483 Participants	169 Participants n=36 Participants
Relationship Separated	14 Participants n=93 Participants	7 Participants n=4 Participants	9 Participants n=27 Participants	10 Participants n=483 Participants	40 Participants n=36 Participants
Relationship Widowed	12 Participants n=93 Participants	13 Participants n=4 Participants	7 Participants n=27 Participants	17 Participants n=483 Participants	49 Participants n=36 Participants
Relationship Unknown or Not Reported	12 Participants n=93 Participants	12 Participants n=4 Participants	9 Participants n=27 Participants	9 Participants n=483 Participants	42 Participants n=36 Participants
Employed? Yes	183 Participants n=93 Participants	165 Participants n=4 Participants	147 Participants n=27 Participants	172 Participants n=483 Participants	667 Participants n=36 Participants
Employed? No	95 Participants n=93 Participants	85 Participants n=4 Participants	89 Participants n=27 Participants	105 Participants n=483 Participants	374 Participants n=36 Participants
Employed? Unknown or Not Reported	12 Participants n=93 Participants	12 Participants n=4 Participants	11 Participants n=27 Participants	8 Participants n=483 Participants	43 Participants n=36 Participants
Health Insurance? Yes	268 Participants n=93 Participants	241 Participants n=4 Participants	228 Participants n=27 Participants	264 Participants n=483 Participants	1001 Participants n=36 Participants
Health Insurance? No	10 Participants n=93 Participants	9 Participants n=4 Participants	9 Participants n=27 Participants	13 Participants n=483 Participants	41 Participants n=36 Participants
Health Insurance? Unknown or Not Reported	12 Participants n=93 Participants	12 Participants n=4 Participants	10 Participants n=27 Participants	8 Participants n=483 Participants	42 Participants n=36 Participants
Insurance Lapse over 12 Months? Yes	27 Participants n=93 Participants	12 Participants n=4 Participants	24 Participants n=27 Participants	24 Participants n=483 Participants	87 Participants n=36 Participants
Insurance Lapse over 12 Months? No	238 Participants n=93 Participants	227 Participants n=4 Participants	200 Participants n=27 Participants	239 Participants n=483 Participants	904 Participants n=36 Participants
Insurance Lapse over 12 Months? Unknown or Not Reported	25 Participants n=93 Participants	23 Participants n=4 Participants	23 Participants n=27 Participants	22 Participants n=483 Participants	93 Participants n=36 Participants
Self-reported Health Status at Baseline Excellent	10 Participants n=93 Participants	10 Participants n=4 Participants	10 Participants n=27 Participants	16 Participants n=483 Participants	46 Participants n=36 Participants
Self-reported Health Status at Baseline Very Good	59 Participants n=93 Participants	52 Participants n=4 Participants	50 Participants n=27 Participants	70 Participants n=483 Participants	231 Participants n=36 Participants
Self-reported Health Status at Baseline Good	121 Participants n=93 Participants	117 Participants n=4 Participants	104 Participants n=27 Participants	114 Participants n=483 Participants	456 Participants n=36 Participants
Self-reported Health Status at Baseline Fair	74 Participants n=93 Participants	62 Participants n=4 Participants	58 Participants n=27 Participants	64 Participants n=483 Participants	258 Participants n=36 Participants
Self-reported Health Status at Baseline Poor	12 Participants n=93 Participants	9 Participants n=4 Participants	15 Participants n=27 Participants	13 Participants n=483 Participants	49 Participants n=36 Participants
Self-reported Health Status at Baseline Missing or Not Reported	14 Participants n=93 Participants	12 Participants n=4 Participants	10 Participants n=27 Participants	8 Participants n=483 Participants	44 Participants n=36 Participants
Subjective Income Level Are comfortable	124 Participants n=93 Participants	134 Participants n=4 Participants	114 Participants n=27 Participants	126 Participants n=483 Participants	498 Participants n=36 Participants
Subjective Income Level Have just enough to make ends meet	109 Participants n=93 Participants	93 Participants n=4 Participants	86 Participants n=27 Participants	108 Participants n=483 Participants	396 Participants n=36 Participants
Subjective Income Level Do NOT have enough to make ends meet	41 Participants n=93 Participants	23 Participants n=4 Participants	36 Participants n=27 Participants	42 Participants n=483 Participants	142 Participants n=36 Participants
Subjective Income Level Missing or Not Reported	16 Participants n=93 Participants	12 Participants n=4 Participants	11 Participants n=27 Participants	9 Participants n=483 Participants	48 Participants n=36 Participants
Subjective Numeracy	4.2 units on a scale STANDARD_DEVIATION 1.3 • n=93 Participants	4.3 units on a scale STANDARD_DEVIATION 1.2 • n=4 Participants	4.2 units on a scale STANDARD_DEVIATION 1.3 • n=27 Participants	4.3 units on a scale STANDARD_DEVIATION 1.2 • n=483 Participants	4.3 units on a scale STANDARD_DEVIATION 1.3 • n=36 Participants
Health Literacy	2.1 units on a scale STANDARD_DEVIATION 2.4 • n=93 Participants	1.9 units on a scale STANDARD_DEVIATION 2.2 • n=4 Participants	2.1 units on a scale STANDARD_DEVIATION 2.2 • n=27 Participants	1.9 units on a scale STANDARD_DEVIATION 2.2 • n=483 Participants	2.0 units on a scale STANDARD_DEVIATION 2.3 • n=36 Participants
Perceived Comparative Risk for Colorectal Cancer Lower than other women/men your age	68 Participants n=93 Participants	54 Participants n=4 Participants	53 Participants n=27 Participants	73 Participants n=483 Participants	248 Participants n=36 Participants
Perceived Comparative Risk for Colorectal Cancer About the same as other women/men your age	111 Participants n=93 Participants	101 Participants n=4 Participants	101 Participants n=27 Participants	110 Participants n=483 Participants	423 Participants n=36 Participants
Perceived Comparative Risk for Colorectal Cancer Higher than other women/men your age	13 Participants n=93 Participants	7 Participants n=4 Participants	15 Participants n=27 Participants	9 Participants n=483 Participants	44 Participants n=36 Participants
Perceived Comparative Risk for Colorectal Cancer Don't know	88 Participants n=93 Participants	92 Participants n=4 Participants	72 Participants n=27 Participants	86 Participants n=483 Participants	338 Participants n=36 Participants
Perceived Comparative Risk for Colorectal Cancer Unknown or Not Reported	10 Participants n=93 Participants	8 Participants n=4 Participants	6 Participants n=27 Participants	7 Participants n=483 Participants	31 Participants n=36 Participants

PRIMARY outcome

Timeframe: 6 months after patient enrollment

Patients' completion of colonoscopy, fecal immunochemical testing (FIT), or other CRC screening within 6 months, based on documentation in the participants' electronic health record.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Who Completed Colorectal Cancer Screening	95 Participants	110 Participants	113 Participants	113 Participants

PRIMARY outcome

Timeframe: 6 months after participant enrollment

Decision quality will be assessed using the multi-dimensional measure of informed consent (MMIC), where a high-quality decision is one where the individual has adequate knowledge regarding the available options and undergoes the screening test that he or she has chosen or that fits his or her values ("values concordance"). Patient knowledge of colorectal cancer and screening will be assessed by a 12-item test made up of 6 multiple choice questions and 6 true-false questions. Adequate knowledge = 9 correct. Concordance will be measured between the patient's test choice at the post-provider survey and the screening test underwent, if any, within 6 months after patient enrollment.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Who Made a High Quality Decision Using the Multi-dimensional Measure of Informed Consent (MMIC) Which Incorporates Knowledge, Intent, and Behavior.	92 Participants	90 Participants	91 Participants	103 Participants

SECONDARY outcome

Timeframe: 6 months after participant enrollment

Colorectal cancer (CRC) screening uptake and type of screening test completed within 6 months of enrolled was assessed, as documented in the electronic health record (EHR).

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Who Completed Colorectal Cancer Screening by Type of Screening Test Completed Completed a stool test (FIT or Cologuard)	56 Participants	51 Participants	61 Participants	62 Participants
Number of Participants Who Completed Colorectal Cancer Screening by Type of Screening Test Completed Completed a colonoscopy	39 Participants	59 Participants	52 Participants	51 Participants
Number of Participants Who Completed Colorectal Cancer Screening by Type of Screening Test Completed Did not complete a CRC screening test	167 Participants	180 Participants	134 Participants	172 Participants

SECONDARY outcome

Timeframe: 1 day (immediately before viewing intervention [baseline/T1] and after viewing intervention [post-intervention/T1]); and approximately 4-30 days after viewing intervention and 4-14 days after provider visit (post-provider visit/T2)

Population: Only participants who completed the item at each time point under comparison were used in the analysis.

Patients' intention to be screened for CRC with any CRC screening test will be measured with 1 item: "Do you plan to get any type of colon cancer screening test within the next 6 months?". The response options were: 5=Definitely; 4=Probably; 3=May or may not; 2=Probably not; and 1=Definitely not. Higher positive change means CRC screening intention increased. Increased intention to be screened is a better outcome.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Average Intention to Get a Colorectal Cancer (CRC) Screening Test of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-intervention (T1)	0.68 score on a scale Standard Deviation 0.86	0.59 score on a scale Standard Deviation 0.79	0.55 score on a scale Standard Deviation 0.84	0.63 score on a scale Standard Deviation 0.83
Average Intention to Get a Colorectal Cancer (CRC) Screening Test of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from post-intervention (T1) to post-provider visit (T2)	0.24 score on a scale Standard Deviation 0.74	0.23 score on a scale Standard Deviation 0.93	0.24 score on a scale Standard Deviation 0.82	0.20 score on a scale Standard Deviation 0.79
Average Intention to Get a Colorectal Cancer (CRC) Screening Test of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-provider visit (T2)	0.94 score on a scale Standard Deviation 1.01	0.85 score on a scale Standard Deviation 1.18	0.80 score on a scale Standard Deviation 1.15	0.82 score on a scale Standard Deviation 1.05

SECONDARY outcome

For those patients who answer the screening intent item with "definitely not," "probably not," or "may or may not", test choice will be categorized as "no screening". Those who answer Screening Intent with "Probably" or "Definitely" have Test Choice categorized based on their answer to a single item: "If you have a colon test, which one would you choose?" Response options are: Stool test (FIT or Cologuard), Colonoscopy, Another test, or Don't know.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Intends to be screened with colonoscopy	58 Participants	70 Participants	56 Participants	79 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Intends to be screened with a stool test (FIT or Cologuard)	53 Participants	62 Participants	55 Participants	70 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Intends to be screened with another test	3 Participants	2 Participants	2 Participants	2 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Intends to be screened and don't know which test	37 Participants	37 Participants	35 Participants	32 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Does not intend to be screened	105 Participants	111 Participants	95 Participants	99 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at baseline (T0) · Unknown or not reported	6 Participants	8 Participants	4 Participants	3 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Intends to be screened with colonoscopy	82 Participants	106 Participants	93 Participants	86 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Intends to be screened with a stool test (FIT or Cologuard)	106 Participants	85 Participants	74 Participants	133 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Intends to be screened with another test	0 Participants	0 Participants	1 Participants	0 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Intends to be screened and don't know which test	18 Participants	25 Participants	19 Participants	19 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Does not intend to be screened	40 Participants	52 Participants	39 Participants	31 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-intervention (T1) · Unknown or not reported	16 Participants	22 Participants	21 Participants	16 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Intends to be screened with colonoscopy	90 Participants	104 Participants	83 Participants	89 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Intends to be screened with a stool test (FIT or Cologuard)	84 Participants	92 Participants	89 Participants	117 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Intends to be screened with another test	1 Participants	1 Participants	0 Participants	1 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Intends to be screened and don't know which test	5 Participants	6 Participants	2 Participants	3 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Does not intend to be screened	25 Participants	26 Participants	25 Participants	27 Participants
Number of Participants Intended Colorectal Cancer (CRC) Screening Behavior Intended screening behavior at post-provider (T2) · Unknown or not reported	57 Participants	61 Participants	48 Participants	48 Participants

SECONDARY outcome

Population: Only participants who completed the item at each time point under comparison were used in the analysis.

Knowledge was assessed with six multiple choice and six true/false questions regarding general information (including risk factors, screening test options, and test frequency) of CRC and CRC screening. Knowledge scores were derived by summing correct responses to the 12 individual knowledge questions (range, 0-12), and change was calculated from baseline (T0) to post-intervention (T1), post-intervention (T1) to post-provider visit (T2), and from baseline (T0) to post-provider (T2) by using the knowledge score at the later time point minus the knowledge score of the former time point. The range for change could be -12 to 12 with higher values meaning an increase in knowledge which is a better outcome.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Average Correct Responses of Participants to Knowledge Questions About Colorectal Cancer (CRC) and CRC Screening: Change Between Baseline, Post-intervention, and Post-provider Visit. Change in correct responses from baseline (T0) to post-intervention (T1)	3.70 units on a scale-number correct Standard Deviation 2.74	3.65 units on a scale-number correct Standard Deviation 2.68	3.75 units on a scale-number correct Standard Deviation 2.82	3.76 units on a scale-number correct Standard Deviation 2.90
Average Correct Responses of Participants to Knowledge Questions About Colorectal Cancer (CRC) and CRC Screening: Change Between Baseline, Post-intervention, and Post-provider Visit. Change in correct responses from post-intervention (T1) to post-provider visit (T2)	-0.58 units on a scale-number correct Standard Deviation 1.31	-0.60 units on a scale-number correct Standard Deviation 1.40	-0.60 units on a scale-number correct Standard Deviation 1.60	-0.43 units on a scale-number correct Standard Deviation 1.45
Average Correct Responses of Participants to Knowledge Questions About Colorectal Cancer (CRC) and CRC Screening: Change Between Baseline, Post-intervention, and Post-provider Visit. Change in correct responses from baseline (T0) to post-provider visit (T2)	3.10 units on a scale-number correct Standard Deviation 2.79	3.03 units on a scale-number correct Standard Deviation 2.71	3.02 units on a scale-number correct Standard Deviation 3.02	3.31 units on a scale-number correct Standard Deviation 2.83

SECONDARY outcome

Population: Only participants who completed the item at each time point under comparison were used in the analysis.

Multiple choice questions assessing the patients' perception of how likely they are to get colon cancer in the next 5 years, in the next 10 years, and sometime during their lifetime. Each has response options: 4=very likely, 3=somewhat likely, 2=somewhat unlikely, and 1=very unlikely. The mean of the 3 questions was calculated (each combined score has a range of 1 to 4) at each time point. We calculated the change from baseline (T0) to post-intervention (T1), post-intervention (T1) to post-provider visit (T2), and from baseline (T0) to post-provider (T2) by using the mean of the later time point minus the mean of the former time point. The range for change could be from -3 to 3 with higher values meaning an increase in perceived risk.

Outcome measures

Outcome measures
Measure	Group 2 n=244 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=267 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=223 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=264 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Average Perceived Personal Colorectal Cancer Risk of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-intervention (T1)	0.15 score on a scale Standard Deviation 0.78	0.21 score on a scale Standard Deviation 0.74	0.14 score on a scale Standard Deviation 0.81	0.08 score on a scale Standard Deviation 0.77
Average Perceived Personal Colorectal Cancer Risk of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from post-intervention (T1) to post-provider visit (T2)	0.12 score on a scale Standard Deviation 0.82	-0.10 score on a scale Standard Deviation 0.86	0.10 score on a scale Standard Deviation 0.87	0.05 score on a scale Standard Deviation 0.83
Average Perceived Personal Colorectal Cancer Risk of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-provider visit (T2)	0.28 score on a scale Standard Deviation 0.87	0.14 score on a scale Standard Deviation 0.79	0.21 score on a scale Standard Deviation 0.98	0.14 score on a scale Standard Deviation 0.84

SECONDARY outcome

Population: Only participants who completed the item at each time point under comparison were used in the analysis.

Patients' decision conflict is assessed using the low literacy version of the Decision Conflict Scale, a ten-item instrument that assesses patients' subjective feeling regarding the decision process over five areas. Each item has three response categories (yes, no, unsure). Scores are summed; divided by 10; and multiplied by 25. Scores range from 0 \[no decisional conflict\] to 100 \[extremely high decisional conflict\]. Negative change means decision conflict decreased. A decrease in decision conflict is a better outcome.

Outcome measures

Outcome measures
Measure	Group 2 n=244 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=267 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=222 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=263 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Average Decision Conflict of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-provider visit (T2)	-41.6 score on a scale Standard Deviation 28.8	-39.0 score on a scale Standard Deviation 29.2	-37.9 score on a scale Standard Deviation 29.2	-39.3 score on a scale Standard Deviation 29.2
Average Decision Conflict of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from baseline (T0) to post-intervention (T1)	-42.4 score on a scale Standard Deviation 27.6	-36.6 score on a scale Standard Deviation 28.9	-37.1 score on a scale Standard Deviation 27.7	-40.3 score on a scale Standard Deviation 28.4
Average Decision Conflict of Participants: Change Between Baseline, Post-intervention, and Post-provider Visit Change from post-intervention (T1) to post-provider visit (T2)	-0.76 score on a scale Standard Deviation 9.53	-1.60 score on a scale Standard Deviation 12.1	-2.32 score on a scale Standard Deviation 11.6	-0.27 score on a scale Standard Deviation 11.6

SECONDARY outcome

Timeframe: approximately 4-30 days after viewing intervention and 4-14 days after provider visit [post-provider visit/T2]

Patients answered four items assessing the extent to which they were involved in the decision-making process. Each item had response options: 1= A lot; 2=Some; 3=A little; 4=Not at all. Each item was analyzed separately and responses "A lot", "Some" and "A little" were considered "enough" and received 1 point. The response "Not at all" was considered "not enough" and received 0 points.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to have a colonoscopy? · Enough	178 Participants	203 Participants	164 Participants	201 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to have a colonoscopy? · Not enough	28 Participants	26 Participants	35 Participants	35 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to have a colonoscopy? · Unknown or not reported	56 Participants	61 Participants	48 Participants	49 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to have a colonoscopy? · Enough	89 Participants	106 Participants	91 Participants	119 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to have a colonoscopy? · Not enough	117 Participants	123 Participants	108 Participants	117 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to have a colonoscopy? · Unknown or not reported	56 Participants	61 Participants	48 Participants	49 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to do a stool test? · Enough	146 Participants	160 Participants	146 Participants	173 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to do a stool test? · Not enough	60 Participants	69 Participants	52 Participants	63 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might want to do a stool test? · Unknown or not reported	56 Participants	61 Participants	49 Participants	49 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to do a stool test? · Enough	92 Participants	108 Participants	93 Participants	111 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to do a stool test? · Not enough	114 Participants	121 Participants	106 Participants	124 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Shared Decision Making Process Survey-4 How much did you and your provider talk about the reasons you might not want to do a stool test? · Unknown or not reported	56 Participants	61 Participants	48 Participants	50 Participants

SECONDARY outcome

Timeframe: approximately 4-30 days after viewing intervention and 4-14 days after provider visit [post-provider visit/T2]

A single-item measure taken from the Colon Cancer Testing Decision Quality Worksheet v.2.0 assessing if the patients' primary care provider asked them which type of colon cancer screening test they wanted.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Decision Quality Instrument Yes	134 Participants	152 Participants	130 Participants	159 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Decision Quality Instrument No	72 Participants	76 Participants	69 Participants	77 Participants
Number of Participants Who Perceive Being Involved in Shared-Decision Making as Assessed by the Decision Quality Instrument Unknown or not reported	56 Participants	62 Participants	48 Participants	49 Participants

SECONDARY outcome

Timeframe: approximately 4-30 days after viewing intervention and 4-14 days after provider visit [post-provider visit/T2]

A 3-item measure assessing how much effort was made by their provider to: explain colon cancer screening, ask for screening preferences, and incorporate those preferences into the decision. Response options ranged from 0="No effort was made" to 9="Every effort was made". The three items were summed and a mean was calculated. Scores can range from 0-9. A higher score indicates more perceived shared decision making. Higher perceived shared decision making is a better outcome.

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Participant's Average Perception of Shared-Decision Making as Assessed by CollaboRATE	6.3 score on a scale Standard Deviation 3.2	6.4 score on a scale Standard Deviation 3.1	6.3 score on a scale Standard Deviation 3.2	6.5 score on a scale Standard Deviation 3.0

SECONDARY outcome

Timeframe: 6 months after patient enrollment

A FIT, colonoscopy, or other CRC screening test ordered within 6 months of each participants' enrollment based on documentation in the electronic health record (EHR).

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Participants With Orders for a Colorectal Cancer Screening (CRC) Test NO order for CRC screening test	84 Participants	89 Participants	79 Participants	84 Participants
Number of Participants With Orders for a Colorectal Cancer Screening (CRC) Test YES order for CRC screening test	178 Participants	201 Participants	168 Participants	201 Participants

SECONDARY outcome

Timeframe: 6 months after patient enrollment

Opening the provider notification sent for each patient was assessed by reviewing the electronic health record (EHR).

Outcome measures

Outcome measures
Measure	Group 2 n=262 Participants Patients view decision aid with personalized message and whose providers do not receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 1 n=290 Participants Patients view decision aid without personalized message and whose providers do not receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification without personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 3 n=247 Participants Patient view decision aid without the personalized message and whose providers receive the personalized message. Decision aid without personalized message: The decision aid without personalized message consists of a PowerPoint presentation converted to mp4 (video) with text, photos, and an audio track, that is advanced by the viewer and can be viewed online. It begins with a 60 sec video on CRC screening produced by the Centers for Disease Control and Prevention (CDC), followed by slides summarizing the advantages and disadvantages of colonoscopy and stool testing with the fecal immunochemical test (FIT) and DNA+FIT (Cologuard). The presentation is approximately 10 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.	Group 4 n=285 Participants Patients view decision aid with the personalized message and whose providers receive the personalized message. Decision aid with personalized message: The decision aid with personalized message will first present the decision aid without personalized message followed by additional PowerPoint slides converted to mp4 (video) with text, photos, and an audio track briefly explaining the risk tool, the participant's score on the 5 risk factors, total score, ACN risk, and implications for screening and test choice. The presentation is approximately 14 minutes long. Provider notification with personalized message: Providers will receive a message informing them that their enrolled patient is due for CRC screening. The notification will also include the patient's ACN risk (very low, low, moderate, high-average) and implications for screening decisions and test choice. Links to a web landing page containing a more detailed explanation of the risk tool and additional references will be included. The notification will be sent to them through the EHR within 24 hours of their visit with the enrolled patient.
Number of Providers Who Open Their Provider Notification Provider notification was opened	161 Participants	181 Participants	153 Participants	175 Participants
Number of Providers Who Open Their Provider Notification Provider notification was not opened	33 Participants	34 Participants	29 Participants	28 Participants
Number of Providers Who Open Their Provider Notification Provider notification was not sent	4 Participants	7 Participants	7 Participants	2 Participants
Number of Providers Who Open Their Provider Notification Unable to determine if provider notification was opened	64 Participants	68 Participants	58 Participants	80 Participants

Adverse Events

Group 1

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Group 2

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Group 3

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Group 4

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Peter H. Schwartz, MD, PhD

Trustees of Indiana University

Phone: 317-278-4037

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place