Dr. Paul Schroy is a graduate of Haverford College, Jefferson Medical School and the Boston University School of Public Health. He completed his residency in Internal Medicine at the North Shore University Hospital (Cornell University) and fellowship in Gastroenterology at the Memorial Sloan-Kettering Cancer Center. Dr. Schroy is a Professor of Medicine at the Boston University School of Medicine and Director of Clinical Research for the Section of Gastroenterology at Boston Medical Center. He is the recipient of a number of grants, which support his ongoing research in the area of colorectal cancer screening and prevention. His current research interests focus on the role of shared decision-making as a strategy for increasing patient participation in colorectal cancer screening, the epidemiology of colorectal neoplasia, the feasibility and validity of novel colorectal cancer screening strategies such as stool-based DNA testing and virtual colonoscopy, and quality issues related to colorectal cancer screening. In addition to his commitment to patient care and clinical research, Dr. Schroy is a founding member and former chair of the Massachusetts Colorectal Cancer Working Group and former member of the Steering Committee of the National Colorectal Cancer Roundtable. He is also the current co-chair of the National Colorectal Cancer Roundtable’s Familial Risk Task Group, a member of the American Cancer Society New England Division's Colorectal Cancer Advisory Committee, and a member of the Massachusetts Department of Public Health’s Cancer Registry Advisory Committee.
Questions and Answers
The most critical aspects of the program are access to the Internet and a primary care practitioner or practice setting that endorses an option-based, patient-centered approach to colorectal cancer screening. The intervention could be adapted for all English-speaking, average-risk individuals 50 to 75 years of age who eligible for colorectal cancer screening. The program has limited utility for patient groups who have a limited screening options due to financial barriers. The program is also not appropriate for high-risk patients for who colonoscopy is the preferred screening methods.
The major facilitators are individual practitioners or practice “thought leaders” who promote a shared decision-making approach for colorectal cancer screening. Time constraints, lack of reimbursement and limited resources (e.g., access to the Internet) are the major challenges. Practitioners who are unwilling to comply with patient preferences, particularly for tests other than colonoscopy, is also a major challenge.
The most important issues related to evaluation would be the ability to measure the proportion of eligible patients due to screening who view the decision aid either at home or as a point of contact intervention, the proportion who have their preferred or an alternate test ordered, and the proportion who complete the preferred or alternate test within a defined time period. No, we do not have a specific evaluation tool to evaluate this program but we refer interested parties to use the Evaluation Toolkit, Version 3 developed by the National Colorectal Cancer Roundtable (http://nccrt.org/about/public-education/evaluation-toolkit/) as a valuable reference.
We are currently exploring the extent to risk stratification impacts on practitioner receptivity to patient preferences, especially among patients deemed to be at low risk of advanced colorectal neoplasia who prefer tests other than colonoscopy.