Purpose: Prostate and colorectal cancer (CRC) screening decisions should incorporate patient preferences. Decision aids (DAs) have been shown to be effective in improving patient decision making, but have not been routinely used in primary care settings. The goals of this study were: 1) assess feasibility of integrating Prostate Specific Antigen (PSA) and CRC screening DAs into routine process of primary care practice, and 2) assess impact of DAs on patient decision making.

Methods: We systematically distributed PSA and CRC screening video DAs to eligible patients (age 50-75) using three distribution strategies at two academic general internal medicine practices. Patients were asked to watch a PSA or CRC screening DA and complete a pre and post-DA questionnaire. Questionnaires assessed pre/post screening intention, knowledge, values influencing the decision, preference for decision making role and DA acceptability.

Results: 1944 PSA DAs and 89 CRC DAs were distributed over 12 months. After watching DAs:

• A substantial number of patients changed their screening intention (PSA 28%, CRC 35%)

• Fewer patients were unsure about their decision (p < .01)

• Fewer patients preferred to have the PSA test (p < .01)

• More patients indicated they would get screened for colon cancer (p = .03)

• Most patients understood key facts about the decision (PSA 92%, CRC 81%)

• For PSA, more patients chose the screening option predicted by their value scores (71% vs. 57%)

• Patients had clear preference for an active role in decision making (PSA 98%, CRC 95%)

• Patients felt DAs were helpful (PSA 86%, CRC 95%) and would recommend them to others (PSA 95%, CRC 100%)

Provider satisfaction was high with the PSA DA distribution strategy.

Conclusions: A systematic visit based strategy is an effective method to distribute cancer screening DAs. After viewing DAs, patients were well informed, clear about their personal values and prepared to make a decision. Patients found DAs acceptable and would recommend them to others. This process is likely to be appropriate for other preference-sensitive decisions in primary care.