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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.