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Wednesday, 18 October 2006 - 10:30 AM


Carmen Lewis, MD, MPH, University of North Carolina at Chapel Hill, Chapel Hill, NC, Jennifer M. Griffith, DrPH, MPH, University of North Carolina at Chapel Hill, Chapel Hill, NC, Alison Tytell Brenner, BA, University of North Carolina at Chapel Hill, Chapel Hill, NC, and Michael Pignone, MD, MPH, University of North Carolina- Chapel Hill, Chapel Hill, NC.

Purpose: We sought to compare, in a randomized trial, two different colon cancer screening decision aid videos to determine the effect of presenting an explicit option of not being screened.

Methods: Adults ages 48-75 not currently up-to-date with screening were randomized to view one of two videos. One video (A) included an explicit discussion of not being screened; the other video (B) did not include an explicit statement that not being screened was an option. Both decision aid videos covered the same screening tests: fecal occult blood (FOBT) testing yearly, sigmoidoscopy every five years, a combination of FOBT and sigmoidoscopy, barium enema every 5 years, and colonoscopy every ten years. Screening interest was assessed before and after using a five-point Likert scale. The post-video questionnaire also included decision satisfaction and decisional conflict scales and selection of a screening test.

Results: 62 adults participated; 37 viewed A and 25 viewed B. Mean age was 55 years, 71% were women, 73% were White, 21% African-American, 95% had graduated high school. Most (55%) had not ever discussed CRC screening with their doctor. Prior to viewing, 26% indicated that they were definitely interested in being screened; after viewing, 39% were definitely interested in screening (p=0.0038). 32% responded to all knowledge questions correctly before, and 81% responded correctly (p=<0.0001) after viewing a video. Mean decisional conflict scores were low (1.8) and mean satisfaction scores were high (25.4). The most frequently selected test was colonoscopy, 46%.

Comparing responses among those who viewed video A versus video B, there were no differences in interest in being screened (2.00 vs. 1.84, p=0.5367) and number responding correctly to all knowledge questions before and after the videos (30% vs. 36% p=0.3929, 81% vs. 80% p=0.3479).Participants viewing video A scored it better in providing information about the possible disadvantages of screening than those viewing Version B (84% vs. 56%, p=0.0161). There were no differences in decisional conflict, satisfaction, or in test selected. Only one participant (who viewed video B) selected not to be screened.

Conclusions: Decision aids can increase knowledge and interest in screening. Inclusion of an explicit “no screening option” does not appear to affect interest. However, the video that included the “no screening option was rated as having better information on disadvantages.

See more of Concurrent Abstracts K: Advancing Decision Support in Medical Decision Making
See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)