WHAT IS THE MOST EFFECTIVE STRATEGY FOR DISTRIBUTING CANCER SCREENING DECISION AIDS IN PRIMARY CARE?

Purpose: Patient decision aids (DAs) enhance knowledge, decrease decisional conflict and promote greater involvement in decision making. However, little data exist on optimal strategies for dissemination. Our objective was to compare different decision aid distribution models.

Methods: From June 2006 – May 2008, eligible patients at a rural academic medical center and a VA hospital received video decision aids for prostate cancer (PSA) or colon cancer screening (CRC) through 4 distribution methods. Measures were DA loans (N), % of eligible patients receiving DA, and patient and provider satisfaction. The number of eligible patients was determined from scheduling data and estimates of % eligible.

Results: Patients received >2500 screening DAs

Distribution Method	Timing	Screening DA	N	Eligible Patient receiving DA (%)
Mailed to all age eligible men	before visit	PSA	1625	~100%
Health tech determines eligibility, patient takes home	after visit	PSA	613	12%
Letter offering DA to all age eligible, mailed upon pt. request	before visit	CRC	84	9%
MD determines eligibility, prescribes at appointment, patient takes home	after visit	PSA CRC	52 33	3% 4%

• The before-visit model led to higher clinician satisfaction with the use of the DAs (before visit - 68% vs. after visit -19%), based on saving time and changing the conversation during the appointment. The before-visit model also facilitated implementation of the decision choice.
• Mailing DAs to all age/gender appropriate patients led to higher circulation among screening- eligible patients, but also led to ineligible patients receiving DAs.
  
• Non-automatic methods of distribution led to low penetration rates of eligible patients.
• Regardless of timing or method of distribution, patients indicated the DAs were helpful in their decision making (95-97%) and would recommend them to other patients (94-98%).
  

Conclusions: Ideally DAs should be available to all eligible patients before their appointments. There are logistical challenges to getting the DAs to the right patients at the right time. In practice the optimal strategy will depend on the decision under consideration, the existing practice structure, goals of the intervention, and resources available.