DO DECISION AIDS ENCOURAGE SHARED DECISION-MAKING? A THEORY-DRIVEN EVALUATION WITH ETHNICALLY DIVERSE PATIENTS

Purpose:  To assess the effects of informational brochures and video decision aids about cancer screening on patient engagement in shared decision making and its predictors in a racially diverse sample.

Methods:  Participants (N=207) were recruited from 13 community-based primary care practices serving racially and ethnically diverse patients in predominately economically disadvantaged neighborhoods. Participants completed theory-based measures (Fishbein’s Integrative Model of Behavior) assessing attitudes, perceived social norms, self-efficacy and intentions for working with their physician to make a cancer screening decision (prostate or colon cancer) after reviewing a brochure (n=107) or video decision aid (n=100), but before seeing the physician. A post-questionnaire assessed screening decisions, participant knowledge and whether participants discussed cancer screening with their physician.

Results:  Most participants were African American (37%) or Latino (41%) and had annual incomes below $25k. Participants’ mean age was 61 years (SD = 9.96) and 54% had a high school diploma or less education. Participants who reviewed a video decision aid had higher knowledge (p = .001) and were more likely to want to be the primary decision-maker (p = .008). Contrary to our hypotheses, they reported lower perceived social norms (p = .001), self-efficacy (p = .001) and intentions (p = .027) to work with their physicians to make a cancer screening decision than participants who reviewed a brochure. Participants who decided against cancer screening reported lower intentions to work with their physician in making a decision (p = .002) and were less likely to report having spoken with their physician about screening (p = .008).

Conclusion:  Viewing a video decision aid led to greater knowledge about cancer screening but lower perceived social norms and self-efficacy for engaging in shared decision-making. Participants who opted against cancer screening after reviewing a brochure or video decision aid were less likely to discuss their decision with their physician. The tendency toward autonomous decision-making was stronger among participants who reviewed a video decision aid.