A COMPUTER-BASED DECISION AID FOR COLORECTAL CANCER (CRC) SCREENING INCREASES PATIENT KNOWLEDGE, SATISFACTION WITH DECISION-MAKING AND INTENTION TO BE SCREENED

Purpose: Shared decision-making has been advocated as a potentially effective strategy for increasing patient adherence to CRC screening recommendations. To facilitate this process, we have developed an interactive, computer-based decision aid to educate patients about the pros and cons of the 5 currently recommended CRC screening options and enable them to identify a preferred option based on personal values. Our decision aid employs videotaped narratives and state-of-the-art graphics to convey key information about CRC and the importance of screening, compare each option using both attribute- and option-based approaches, and elicit patient preferences. The goal of this study was to assess the impact of our decision aid on user knowledge, satisfaction with the decision-making process and intention to complete a screening test. Methods: Asymptomatic, average-risk patients (age, 50-75) without prior screening (except possibly fecal occult blood testing) were randomized to one of two intervention arms (I = decision aid plus personalized risk assessment; II = decision aid alone) or a control arm. The interventions took place just prior to a scheduled visit prearranged by their primary care providers to discuss CRC screening. After meeting with their providers, subjects were asked to complete a self-administered posttest that included 12 true-false knowledge questions, the 12-item “satisfaction with the decision-making process” scale and a single item “intention” scale. Intergroup comparisons were performed using Chi-square analysis or ANOVA. Results: A total of 562 English-speaking subjects (mean age, 57 years; 60% female; 61% Black, 6% Hispanics) were randomized. The 3 groups were well-balanced with respect to age, sex, race, ethnicity and education. Results are summarized in the table below. Mean cumulative knowledge scores, mean cumulative satisfaction with decision-making process scores and mean intention scores were significantly higher for both intervention groups compared with the control group. Conclusions: Our interactive computer-based decision aid increases patient knowledge about CRC and screening, satisfaction with the decision-making process and intention to be screened.

		Mean Score (S.D.)
	Scoring System	Intervention I	Intervention II	Control
Posttest Knowledge	Max=12	10.6 (1.8)*	10.8 (1.7)*	8.6 (2.4)
Satisfaction with Decision-Making Process	Max=60	50.8 (5.8)*	50.6 (5.6)*	47.1 (7.8)
Intention	Likert 1-5 (5= very likely to 1=very unlikely)	4.3 (1.1)*	4.3 (1.0)*	3.9 (1.3)

*Intervention(s) vs. Control, P<0.001