A Decision Aid to Promote Appropriate Colorectal Cancer Screening among Older Adults: A Randomized Controlled Trial

Carmen L. Lewis, Christine E. Kistler, Alexandra F. Dalton, Carolyn Morris, Renée Ferrari, Colleen Barclay, Noel T. Brewer, Rowena Dolor, Russell Harris, Maihan Vu and Carol E. Golin
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Carmen L. Lewis: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
Christine E. Kistler: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Alexandra F. Dalton: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
Carolyn Morris: University of Colorado School of Medicine, Aurora, CO, USA
Renée Ferrari: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Colleen Barclay: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Noel T. Brewer: Department of Health Behavior, Gillings School of Global Health, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Rowena Dolor: Division of General Internal Medicine, Department of Medicine, Duke School of Medicine, Durham, NC, USA
Russell Harris: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Maihan Vu: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Carol E. Golin: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Medical Decision Making, 2018, vol. 38, issue 5, 614-624

Abstract: Background. Concerns have been raised about both over- and underutilization of colorectal cancer (CRC) screening in older patients and the need to align screening behavior with likelihood of net benefit. Objective. The purpose of this study was to test a novel use of a patient decision aid (PtDA) to promote appropriate CRC screening in older adults. Methods. A total of 424 patients ages 70 to 84 y who were not up to date with CRC screening participated in a double-blinded randomized controlled trial of a PtDA targeted to older adults making decisions about whether to undergo CRC screening from March 2012 to February 2015. Intervention. Patients were randomized to a targeted PtDA or an attention control. The PtDA was designed to facilitate individualized decision making—helping patients understand the potential risks, benefits, and uncertainties of CRC screening given advanced age, health state, preferences, and values. Outcomes. Two composite outcomes, appropriate CRC screening behavior 6 mo after the index visit and appropriate screening intent immediately after the visit, were defined as completed screening or intent for patients in good health, discussion about screening with their provider for patients in intermediate health, and no screening or intent for patients in poor health. Health state was determined by age and Charlson Comorbidity Index. Results. Four hundred twelve (97%) and 421 (99%) patients were analyzed for the primary and secondary outcomes, respectively. Appropriate screening behavior at 6 mo was higher in the intervention group (55% v. 45%, P = 0.023) as was appropriate screening intent following the provider visit (61% v. 47%, P = 0.003). Limitations. The study took place in a single geographic region. The appropriate CRC screening classification system used in this study has not been formally validated. Conclusions. A PtDA for older adults promoted appropriate CRC screening behavior and intent. Trial Registration: Clinicaltrials.gov, registration number NCT01575990. https://clinicaltrials.gov/ct2/show/NCT01575990?term=epic-d&rank=1

Keywords: appropriate screening; appropriate use; colorectal cancer screening; decision aid; overuse; underuse (search for similar items in EconPapers)
Date: 2018
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:38:y:2018:i:5:p:614-624

DOI: 10.1177/0272989X18773713

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