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Tuesday, October 21, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Background:
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States yet screening rates were approximately 50% in 2004. Barriers include lack of physician time and inadequate patient education. It is not known whether a physician-prescribed decision aid (DA) video detailing CRC screening options influences screening rates.
Methods:
A consecutive cohort of English speaking patients between 49-80 years who were eligible for CRC screening and had the video, “Colon Cancer Screening: Deciding What’s Right for You,” prescribed in an academic primary care practice between June 1, 2005 – November 30, 2006 were included. Exclusion criteria included personal or family history of CRC or an indication for diagnostic colonoscopy. Up to three controls with an index visit within 2 weeks of the video prescription date were matched on age, gender, insurance status, and physician loyalty.
Charts were abstracted for demographics, CRC screening procedure and date, and co-morbidities defined by the Charlson Index (CI). CRC screening subsequent to the index date was the primary outcome. The relationship between CRC screening and video prescription, controlling for non-matched features (race, CI, and prior screening) was examined using multivariable logistic regression.
Results:
119 subjects and 290 matched controls were identified. Median length of follow-up was 628 days. The cohort had the following characteristics: mean age 60 years, 65% female, 84% white, 64% commercial insurance and 27% Medicare. Raw screening rates were 32% in the SDM video cohort and 42% in the control group (p=0.06).
In the multivariable analysis, patients receiving the video were less likely to be screened compared to controls (OR 0.62, 95% CI 0.39, 0.98; p= 0.042). Patients with CI of 1 or greater were less likely to be screened compared to patients with CI =0 (OR 0.60, 95% CI 0.39, 0.92; p= 0.02).
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States yet screening rates were approximately 50% in 2004. Barriers include lack of physician time and inadequate patient education. It is not known whether a physician-prescribed decision aid (DA) video detailing CRC screening options influences screening rates.
Methods:
A consecutive cohort of English speaking patients between 49-80 years who were eligible for CRC screening and had the video, “Colon Cancer Screening: Deciding What’s Right for You,” prescribed in an academic primary care practice between June 1, 2005 – November 30, 2006 were included. Exclusion criteria included personal or family history of CRC or an indication for diagnostic colonoscopy. Up to three controls with an index visit within 2 weeks of the video prescription date were matched on age, gender, insurance status, and physician loyalty.
Charts were abstracted for demographics, CRC screening procedure and date, and co-morbidities defined by the Charlson Index (CI). CRC screening subsequent to the index date was the primary outcome. The relationship between CRC screening and video prescription, controlling for non-matched features (race, CI, and prior screening) was examined using multivariable logistic regression.
Results:
119 subjects and 290 matched controls were identified. Median length of follow-up was 628 days. The cohort had the following characteristics: mean age 60 years, 65% female, 84% white, 64% commercial insurance and 27% Medicare. Raw screening rates were 32% in the SDM video cohort and 42% in the control group (p=0.06).
In the multivariable analysis, patients receiving the video were less likely to be screened compared to controls (OR 0.62, 95% CI 0.39, 0.98; p= 0.042). Patients with CI of 1 or greater were less likely to be screened compared to patients with CI =0 (OR 0.60, 95% CI 0.39, 0.92; p= 0.02).
Conclusion:
Prescription of a SDM video detailing CRC screening options was associated with lower screening rates. Patients with comorbid illnesses were also screened less often, while race and prior screening were not significant predictors. Whether this lower rate of CRC screening among patients with co-morbidities is clinically appropriate needs further research. Our main findings could have two explanations: either the DA discouraged screening or it was preferentially prescribed to patients reluctant to undergo screening.
Further research is needed to address this question.
See more of: Poster Session IV
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)