H-2 PSA AND COLON CANCER SCREENING - EVIDENCE OF DECISION QUALITY WHEN DECISION AIDS ARE USED

Tuesday, October 21, 2008: 2:45 PM
Grand Ballroom B/C (Hyatt Regency Penns Landing)
W. Blair Brooks, MD1, Charles Brackett, MD, MPH1, Nan Cochran, MD2, Martha Coutermarsh1, Catharine F. Clay, MA, BSN3 and Stephen Kearing, MS4, (1)Dartmouth-Hitchcock Medical Center, Lebanon, NH, (2)White River Junction VA Medical Center, White River Junction, VT, (3)Dartmouth Hitchcock Medical Center, Lebanon, NH, (4)Dartmouth Medical School, Hanover, NH

Purpose: One of the International Patient Decision Aid Standards (IPDAS) criteria indicates an effective decision aid should improve decision quality (i.e., �the match between the chosen option and features that matter most to the informed patient�). Our objective was to determine if decision aids could improve decision quality for patients choosing to get screened for prostate or colon cancer.

Methods: From January 2006 � May 2008, eligible patients systematically received a video decision aid to help them with decisions about PSA testing and colon cancer screening (CRC).� Participants: 1) complete a pre-DA questionnaire, 2) watch a condition-specific video decision aid, and 3) complete a post-DA questionnaire.� Measures: pre/post-video screening intention, knowledge of key facts, patient values scores (category scale: 1-10 importance). A chart review was conducted to determine if patients followed through with their decisions.

Results: After watching the video decision aid: 1) most patients demonstrated an understanding of key facts associated with the screening decision (average knowledge score: PSA 93%, CRC 78%),���� 2) a substantial proportion of patients changed their screening intention (PSA: 24%, CRC 30%), and 3) more patients chose the screening option predicted by their values scores (p ≤ .05).� Patients who felt it was more important to �Know if you have cancer� and �Find cancer early� were more likely to opt for screening (p ≤ .05). �Patients watching the PSA DA were less likely to opt for screening, while those watching the CRC DA were more likely to choose screening (p ≤ .05).� Patients indicating they would get screened were more likely to do so.

Conclusions: For these patients, decision aids appear to improve decision quality by helping them choose the screening option that is concordant with the values that are more important to them.� These results suggest that when patients are provided information regarding the risks and benefits of cancer screening, they are likely to follow through with their choice.

Intention after DA

N

Got screened

N (row %)

PSA Screening

214

173 (81)

No PSA screening

150

�47 (32)

Unsure

�64

�42 (65)

TOTAL

428

262 (61)

CRC Screening

39

27 (69)

No CRC Screening

�13

�5 (38)

Unsure

�6

3 (50)

TOTAL

58

35 (60)

See more of: Concurrent Session Abstracts H: Decision Making Quality and Satisfaction

See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)