Trial Outcomes & Findings for Promoting Informed Decisions About Cancer Screening in Older Adults (NCT NCT03959696)

Last Updated: 2025-01-06

Results Overview

The SDMP scale is a short, patient-reported scale that asks patients about discussion of options, pros and cons of colonoscopy and discussion of patients' preferences. Total scores range from 0-4, with higher scores indicating more shared decision making.

Recruitment status

COMPLETED

Study phase

Target enrollment

536 participants

Primary outcome timeframe

About 1 week after the physician visit

Results posted on

2025-01-06

Participant Flow

From May - August 2019, physicians enrolled onto the study from Internal Medicine and Family Medicine practices affiliated with five hospital networks-three academic medical centers and two community hospitals in the Northeast US. We targeted about 10 patients per physician from October 2019-April 2021. We anticipated enrolling 500 patients. Enrolled patients were able to invite a companion, if applicable

Participant milestones

Participant milestones
Measure	Notification Only Arm/Providers Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Notification Only Arm/Patients Eligible patients who completed a visit with a participating physician in the 'notification only' arm. Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/Providers Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.	Training and Notification Arm/Patients Eligible patients who completed a visit with a participating physician in the 'training and notification' arm. Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.	Notification Only Arm/Companion Enrolled patients were able to invite a companion, if applicable	Training and Notification Arm/Companion Enrolled patients were able to invite a companion, if applicable
Overall Study STARTED	31	230	28	236	5	6
Overall Study COMPLETED	31	230	28	236	5	6
Overall Study NOT COMPLETED	0	0	0	0	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Notification Only Arm/Providers n=31 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Notification Only Arm/Patients n=230 Participants Eligible patients who completed a visit with a participating physician in the 'notification only' arm. Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/Providers n=28 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.	Training and Notification Only Arm/Patients n=236 Participants Eligible patients who completed a visit with a participating physician in the 'training and notification' arm. Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.	Notification Only Arm / Companions n=5 Participants Enrolled patients were able to invite a companion, if applicable	Training and Notification Arm/ Companions n=6 Participants Enrolled patients were able to invite a companion, if applicable	Total n=536 Participants Total of all reporting groups
Age, Continuous	52.4 years STANDARD_DEVIATION 9.0 • n=99 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	79.2 years STANDARD_DEVIATION 2.8 • n=107 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	53.1 years STANDARD_DEVIATION 10.0 • n=206 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	79.5 years STANDARD_DEVIATION 2.8 • n=7 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	70 years STANDARD_DEVIATION 11 • n=31 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	77 years STANDARD_DEVIATION 12 • n=30 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.	79.4 years STANDARD_DEVIATION 2.8 • n=3 Participants • The analytic set are the eligible patients who completed a survey. Three patients were removed after determining they did not meet eligibility criteria.
Sex: Female, Male Female	16 Participants n=99 Participants • The patients who completed a survey	111 Participants n=107 Participants • The patients who completed a survey	14 Participants n=206 Participants • The patients who completed a survey	138 Participants n=7 Participants • The patients who completed a survey	4 Participants n=31 Participants • The patients who completed a survey	3 Participants n=30 Participants • The patients who completed a survey	286 Participants n=3 Participants • The patients who completed a survey
Sex: Female, Male Male	15 Participants n=99 Participants • The patients who completed a survey	119 Participants n=107 Participants • The patients who completed a survey	14 Participants n=206 Participants • The patients who completed a survey	98 Participants n=7 Participants • The patients who completed a survey	1 Participants n=31 Participants • The patients who completed a survey	3 Participants n=30 Participants • The patients who completed a survey	250 Participants n=3 Participants • The patients who completed a survey
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	2 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	4 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	6 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Ethnicity (NIH/OMB) Not Hispanic or Latino	30 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	222 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	28 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	229 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	509 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Ethnicity (NIH/OMB) Unknown or Not Reported	1 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	6 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	3 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	5 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	6 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	21 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) Asian	7 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	1 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	4 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	3 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	15 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) Black or African American	2 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	4 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	4 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	10 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) White	22 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	215 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	24 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	219 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	480 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) More than one race	0 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=99 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	10 Participants n=107 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	0 Participants n=206 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	10 Participants n=7 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	5 Participants n=31 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	6 Participants n=30 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.	31 Participants n=3 Participants • The analytic subset are the eligible patients who completed a survey. 3 patients were late ineligible due to: other major health issue, up to date on screening, returned survey too late.
Region of Enrollment United States	31 participants n=99 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	230 participants n=107 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	28 participants n=206 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	236 participants n=7 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	5 participants n=31 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	6 participants n=30 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.	536 participants n=3 Participants • The patients and companions who completed a survey. The physicians who enrolled patients.

PRIMARY outcome

Timeframe: About 1 week after the physician visit

Population: This analytic sample includes patients who completed the survey and completed data on all four SDM Process questions.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=222 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=232 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Shared Decision Making Process (SDMP) Scale Score	1.1 Score on a scale Standard Deviation 1.2	1.5 Score on a scale Standard Deviation 1.2

SECONDARY outcome

Timeframe: 1 week after physician visit

Population: The data is of patients who answered at least 4 of the 7 questions.

Colorectal Cancer (CRC) Screening Knowledge will be assessed with multiple choice knowledge items adapted from the CRC Decision Quality Instrument. A total score from 0-100% will be calculated based on the number of correct answers, with higher scores indicating higher knowledge.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=221 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=228 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Patients' Colorectal Cancer Screening Knowledge Score	61 score on a scale Standard Deviation 18.8	63 score on a scale Standard Deviation 17.7

SECONDARY outcome

Timeframe: 1 week after physician visit (preference); 12 months after physician visit (testing)

Population: 450 patients who indicated a clear preference on the post visit survey were analyzed. The population excludes 4 who indicated 'other' and 12 who did not answer the question.

Colorectal Cancer Screening Preference assessed with 1 item adapted from the CRC Decision Quality Instrument will be compared with the screening approach followed (assessed via chart review and patient report) to determine the percentage of patients who received preferred approach to testing.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=223 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=227 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Percentage of Patients Who Received Preferred Approach to Colorectal Cancer Testing	103 Participants	115 Participants

SECONDARY outcome

Timeframe: Baseline

Population: Physicians who completed a recorded simulated patient interaction with a standardized patient.

The transcripts from the simulated patient interactions will be scored by two coders using Braddock's Informed Decision Making framework. Total scores range from 0-9 with higher scores indicating more shared decision making elements in the interaction.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=26 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=28 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Physician's Shared Decision Making Skills	5.5 Score on a scale Standard Deviation 1.3	6.1 Score on a scale Standard Deviation 1.6

SECONDARY outcome

Timeframe: 1 year

Population: 466 enrolled patients whose chart was reviewed for completion of cancer screening

The chart review results of cancer screening rates for patients enrolled in the study.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=230 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=236 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Colorectal Cancer Screening Rates	29.1 percentage of participants Interval 23.3 to 35.5	38.6 percentage of participants Interval 32.3 to 45.1

SECONDARY outcome

Timeframe: 1 week post visit

Population: 59 participating physicians completed post-visit surveys for 376 participating patients.

The percentage of study patient visits where the clinicians' reported that they were 'extremely or very satisfied' will be compared across arms.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=176 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=200 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Clinician Satisfaction With the Visit	138 Participants	171 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: About a week after physician visit

Population: Very few patients indicated that they had a companion (spouse, friend, family member) with them at the visit. If a name was provided, companions were contacted and ask to complete a post-visit survey. 11 companions were identified, but only 10 completed the SDM Process questions.

Companions will complete an adapted version of the SDM Process survey to provide a different perspective on the conversation and involvement of the patient. A total score will range from 0-4, with higher scores indicating more shared decision making.

Outcome measures

Outcome measures
Measure	Notification Only Arm/ Patients n=5 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening.	Training and Notification Arm/ Patients n=6 Participants Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content. Notification: Clinicians will be notified of their patients aged 76-85 with an upcoming, non urgent visit who are due for colorectal cancer screening. Training: The 2-hour continuing medical education course in shared decision making, simulated patient interaction to practice skills, and monthly calls for a year to review difficult cases with clinical and shared decision making experts.
Companion SDM Process Scale Score	2.1 Score on a scale of 0-4 Standard Deviation 1.3	1.9 Score on a scale of 0-4 Standard Deviation 1.2

OTHER_PRE_SPECIFIED outcome

Timeframe: Baseline

Population: Comparator physicians' reported confidence of shared decision making and barriers to shared decision making on a baseline survey is compared to Intervention physicians' reported confidence of shared decision making and barriers to shared decision making after completion of the training webinar.

The investigators will use five items to assess clinicians' confidence in Shared Decision Making Skills and Barriers to SDM. A total confidence score (0-20) with higher scores indicating higher confidence and a barrier score (0-8) higher scores indicating more barriers will be calculated.