FACTORS IN INFORMED DECISION MAKING IN HEPATITIS C TESTING

Purpose:  More than 3 million Americans are infected with hepatitis C virus (HCV). There is disagreement on the utility of routine testing for those at increased risk.  We educated and assisted at-risk patients in making an informed decision about HCV testing using decision counseling, a method to aid patients in making a decision in line with their values and preferences.  

Method:  Patients were eligible to participate if they had at least one HCV risk factor (injection drug use, time in prison or jail, tattooing, partner with HCV, needle-stick injury, kidney dialysis or blood transfusion). Patients completed a baseline survey, attended a session with a health educator to review a study-specific booklet and underwent decision counseling.  During decision counseling, patients provided up to three factors (reasons) for or against HCV testing and rated their factors based on intensity of feeling and the level of influence.  A preprogrammed algorithm computed their preference (for or against testing).  After decision counseling, patients had the opportunity to talk about testing with their physician. We content analyzed the factors for or against testing and used SPSS to calculate the number of factors per patient.

Result: Seventy-eight patients met with a health educator and 70 (90%) agreed to have decision counseling. Among those who completed decision counseling, 79% preferred to be tested for HCV, 1% were neutral about testing, and 20% preferred not to test. Among those who preferred to test 40% listed two factors in favor of testing, 38% listed one factor, and 22% listed three factors.  The most frequent factor was wanting to know their HCV status (31%), followed by being worried about having a risk factor (29%).  Among those not in favor of testing, 64% provided one factor against testing, and 36% provided two factors.  No one provided three factors against testing.  The most frequent factor (73%) for not testing was not feeling the need to test.  Twenty-three patients (42%) who were in favor of testing have tested, while none of the patients not in favor of testing have tested.

Conclusion: This brief informed decision making effort appears to be an effective way to assist at-risk patients in making a decision about hepatitis C testing that is in line with their personal values and preferences.