Supplemental materials for: Krist AH, Woolf SH, Hochheimer C, et al. Harnessing information technology to inform patients facing routine decisions: cancer screening as a test case. Ann Fam Med. 2017;15(3):217-224. This supplemental material has been supplied by the author and has not been edited by Annals of Family Medicine.
APPENDIX 1. MyQuestions Informed Decision Making Module 1. MyPreventiveCare patient portal home page
2. Alert to start MyQuestions in the patient dashboard
3. MyQuestions opening page
4. MyQuestions question #1
5. MyQuestions question #2
6. MyQuestions question #3
7. MyQuestions transition page
8. MyQuestions question #4
9. MyQuestions transition page
10. MyQuestions question #5
11. MyQuestions question #6
12. MyQuestions question #7
13. MyQuestions transition page
14. MyQuestions question #8
15. MyQuestions question #9
16. Patient created decision aid Tiles with information patient said was very important (question 4) in the format they wanted to see the information (question 5). Up to four tiles were included, although patients could access all resources (for all topics and all formats) by clicking on More information about Colon Cancer Screening.
17. Example of content in patient educational material tile
18. Patient can access a library of all educational material
19. MyQuestions question #10
20. MyQuestions question #11
21. MyQuestions question #12
22. MyQuestions question #13
23. MyQuestions question #14
24. MyQuestions question #15
25. MyQuestions question #16 Invitation to have visit audio recorded
26. MyQuestions transition page
27. MyQuestions question #17
28. MyQuestions Action Page created by patient responses to above questions
29. Example of summary of patient responses in the clinician s electronic health record
APPENDIX 2. Patient Post-Encounter Survey When you visited MyPreventiveCare on [date], you received a notice that you should think about whether you should have [cancer screening test]. 1. Have you already had the [cancer screening test] or gotten a referral or appointment to get the test? o Yes [GO TO 2] o No [GO TO 3] 3. At this point, how far along are you with making a choice about [cancer screening test]? (from OPDG 1) o I have not yet thought about the options o I am thinking about the options o I am close to making a choice (e.g., scheduling the test) o I have already made a choice o Other: [free text box appears] 2. When did you get the [cancer screening test], referral, or appointment to get the test? o I got it before my doctor s appointment on [date]. [GO TO 14] o I got it at the doctor s appointment on [date]. [GO TO 4] We would like your feedback on your doctor s appointment and the questionnaire you completed (MyQuestions) when you visited MyPreventiveCare. o I got it after the doctor s appointment on [date]. [GO TO 4] BEFORE YOUR APPOINTMENT ([date] to [date]) 4. After you visited MyPreventiveCare, did you do any the following before your appointment? [check all that apply] o I didn t do anything further. o I talked about screening with people I trust [check all that apply] Family Friends People who have been through screening before Clergy A specialist for a second opinion Other: [free text box appears] o I did more reading and research. o I prayed o Other: [Free text box appears] For group 2 only: 4a. When you completed MyQuestions you said you did not want your responses sent to your doctor. Can you tell us why? [free text box] In particular, I remember learning more about [cancer screening test] through [check all that apply]: o o o o o o Internet research or other online information Television programs or videos Printed materials print magazines or newspapers Printed materials (such as pamphlets) from doctor s office or other health organizations I completed a decision aid. For example, filling out a printed or online questionnaire that could help me weigh pros and cons. Something else [Free Text Box appears] For group 3 only: 4b. When you visited MyPreventive Care you chose not to complete the MyQuestions survey. Can you tell us why? [free text box]
YOUR APPOINTMENT ([date]) 5. At your appointment, did you feel that your doctor had seen your responses to MyQuestions? a. Yes b. No c. I cannot remember 6. Did your doctor discuss [cancer screening test] with you at your appointment? a. Yes [GO TO 7] b. No [GO TO 14] c. I cannot remember [GO TO 13] 7. Which best describes how your use of MyPreventiveCare on [date] changed your conversation with your doctor? (check all that apply) o o o o It motivated me to talk with my doctor about [cancer screening test] IF CHOSEN It prompted my doctor to talk with me about [cancer screening test] IF CHOSEN Something else? [free text box appears] It didn t really change things 8. For each item below, please check the boxes to indicate which specific questions you had about [cancer screening test] at the time of your appointment, whether your doctor discussed them, and whether you got the information you needed. 7a. Did it motivate you to discuss the questions you listed as important? Yes No 7b. Do you think it motivated your doctor to discuss the questions you listed as important? Yes No Rated most important by you when you completed MyQuestions [date] TOPICS What are my options for getting screened or not getting screened? How much would screening improve my chances of living longer? Does one kind of screening test work better than another? What problems (inaccurate test results, complications, unnecessary treatments) does screening cause? What do expert organizations (e.g., American Cancer Society) recommend? How is the screening test performed? How common is the cancer I had this question at the time of my appointment I discussed this with my doctor at my appointment I got the information I needed
and how dangerous is it? What are the costs, location, transportation, and other logistics? [Placeholder for topic patient added in MyQuestions Q4] Something else [free text box appears] 9. On [date] you said that [xxxxx, xxxxx, and xxxxx] were your greatest fears or worries about [cancer screening test] was. How did your conversation with your doctor help you with any of these fears? [question would not appear if no fears chosen on IDM module] o The conversation helped reduce these fears or worries. o The conversation did not help me with these fears or worries. 10. What we read or hear from doctors is sometimes less important than our core beliefs. How much do you agree with the following core beliefs about [cancer screening test]? Strongly disagree Disagree somewhat Neither agree nor disagree Agree somewhat The dangers of cancer make screening a good idea. Strongly agree The risks of screening make screening a bad idea. Cancer screening cannot change what happens to my health Screening only makes sense when a person has a family history of cancer Screening only makes sense when a person has symptoms (warning signs of cancer) Screening is unnecessary for someone my age 11. Did you make a final decision during your appointment, to either get screened or not get screened? a. Yes [GO TO 12] b. No [GO TO 13] c. Not applicable: Please explain why [free text box appears] [GO TO 13] 12. How would you describe how you made the decision about [cancer screening test]? o I made the decision about [cancer screening test] without help from my doctor. o I made the decision about [cancer screening test] after seriously considering my doctor s opinion. o My doctor and I shared responsibility for deciding which cancer screening option is best for me. o My doctor made the final decision but seriously considered my opinion. o I left all decisions regarding [cancer screening test]to my doctor.
13. How would you describe the amount of time you and your doctor spent discussing [cancer screening test]? o Not enough time. o Enough time. o Too much time o I can t remember.
GIVE US YOUR FEEDBACK 14. What is your reaction to completing MyQuestions? For each statement below, please let us know how strongly disagree or agree. Screen shot of MyQuestions Strongly disagree Disagree somewhat Neither agree nor disagree It was easy to complete Agree somewhat Strongly agree It improved my knowledge of [cancer screening] before my appointment It got me more involved in the decision. It helped me with my decision about [cancer screening test] It helped change my plans for screening It had a look (layout) that made it easy for me to understand It had too much detail It took too long to complete It made my doctor more sensitive to my concerns It improved my communication with my doctor at my appointment It made my appointment more productive Other comments: [text box appears] 15. What else could we add to MyPreventiveCare to help you? [free text box appears]
APPENDIX 3. Clinician Post Encounter Survey You had an office visit with [patient name] on [date]. The patient asked MyPreventiveCare to to send you [his/her] questions and concerns regarding [cancer screening test]. 1. Do you recall seeing the summary of the patient s concerns in your EMR at any time before you met with the patient? o Yes o No Screen shot to illustrate what summary looks like on screen 2. As of now, has the patient already had the [cancer screening test] or obtained a referral or appointment to get the test? o Yes [GO TO 3] o No [GO TO 4] o I don t know the screening status of the patient [GO TO 4] 4. Did you discuss [cancer screening test] with the patient at the [date] appointment? o Yes [GO TO 5] o No [GO TO 11] o I can t remember [GO TO 11] 5. At the [date] appointment, did you know what topics about [cancer screening test] were most important to the patient? o Yes [GO TO 6] o No [GO TO 7] 3. When did the patient get the [cancer screening test], referral, or appointment to get the test? Before the [date] appointment with me. [GO TO 11] At the [date] appointment with me. [GO TO 4, but skip 8 and go directly to 9] After the [date] appointment with me. [GO TO 4] 6. How did you know? [Click all that apply] o Prior discussions with the patient. o The summary I received from MyPreventiveCare. o The patient told me during the [date] appointment. 7. Which best describes how the patient s completion of MyQuestions and forwarding the summary changed your conversation with the patient?. (check all that apply) o It motivated the patient to talk with me about [cancer screening test] IF CHOSEN o It prompted me to talk with the patient about [cancer screening test] IF CHOSEN o Something else? [free text box appears] o It didn t really change things 8. For each item below, please check the boxes to indicate which specific topics about [cancer screening test] you thought were of interest to the patient, whether you discussed the topic(s), and whether you think the patient received the information he/she needed. 7a. Do you think it motivated [him/her] to discuss the questions [he/she] listed as important? Yes No 7b. Did it motivate you to discuss the questions the patient listed as important? Yes No TOPICS Options for getting screened This topic was of interest to the patient I discussed this with the patient at the [date] appointment The patient received the information he/she needed
or not getting screened How much screening would improve survival How one kind of screening test compares with another Problems (inaccurate test results, complications, unnecessary treatments) caused by screening What expert organizations (e.g., American Cancer Society) recommend How the screening test is performed How common is the cancer and how dangerous it is Costs, location, transportation, and other logistics [Placeholder for topic(s) patient added in MyQuestions Q4] Something else [free text box appears] 9. Do you recall addressing any fears or worries expressed by the patient about [cancer screening test]? o Yes o No o I can t recall 10. Did the patient make a final decision during the appointment, to either get screened or not get screened? o Yes [GO TO 11] o No [GO TO 12] o Not applicable: Please explain why [free text box appears] [GO TO 12] 11. How would you describe how the decision about [cancer screening test] was made? o The patient made the decision about [cancer screening test] without help from me. o The patient made the decision about [cancer screening test]after seriously considering my opinion. o The patient and I shared responsibility for deciding which cancer screening option is best for the patient. o I made the final decision but seriously considered the patient s opinion. o The patient left all decisions regarding [cancer screening test]to me. 10. How would you describe the amount of time you and the patient spent discussing [cancer screening test]? o Not enough time. o Enough time. o Too much time o I can t remember.
11. What was the outcome of the patient s visit to MyPreventiveCare ahead of the appointment and the summary you received in the EMR? OUTCOMES FOR THE PATIENT Strongly disagree Disagree somewhat Neither agree nor disagree Agree somewhat Strongly agree It improved the patient s knowledge of [cancer screening] before the appointment. It got the patient more involved in the decision. It helped the patient with the decision It helped change the patient s plans for screening Fill in: [text box appears] OUTCOMES FOR ME Strongly disagree Disagree somewhat Neither agree nor disagree Agree somewhat It reminded me that the patient was due for [cancer screening test] Strongly agree It made me more sensitive to the patient s concerns It helped me know what types of information to share with the patient It led me to offer different screening options than I might have offered otherwise It improved my communication with the patient at the appointment It made the appointment more productive Fill in: [text box appears]