Purpose: Decision aids (DAs) have been shown to facilitate shared decision making (SDM) about cancer screening. Pre-visit delivery to appropriate patients is challenging, but allows the patient to arrive at the visit better prepared to make their decision. Our goal was to use a web-based survey system to identify and provide prostate cancer screening (PSA) and colorectal cancer screening (CRC) DAs to appropriate patients prior to a preventive medicine visit.
Methods: Patients complete a web-based health history questionnaire before their preventive medicine appointment. Age and gender appropriate patients are asked further questions to determine eligibility for PSA or CRC screening. Screening-eligible patients are presented with a brief description of the screening decision to be made, asked their screening preference, and offered the choice of a video or print DA. Patients are then asked to complete questions assessing their knowledge and values regarding the screening question. Feedback on incorrect answers to knowledge questions and another offer of further information are displayed on a written report given to the patient. Patients´ screening choice and responses to knowledge and values questions are fed forward to a clinician report available at the visit.
Results: From January 2008 – March 2011, 4384 PSA and 11493 CRC questionnaires were completed. The questionnaire properly identified patients eligible for screening: 2962 (68%) for PSA and 2187 (19%)for CRC. 15% of eligible patients requested a DA, with the majority of those preferring the written format over video. 16% of patients declined a DA because they preferred the doctor make the decision. Many patients declined a DA because they “already know enough to make their decision” (50% for PSA, 31% for CRC). PSA knowledge scores for patients who “already knew enough” were significantly higher than those requesting additional information (mean(SD): 79(21) vs. 63(32), T-test, p < 0.0001). This prior knowledge was due in large part to 41% of patients having received the PSA DA during a previous intervention.
Conclusions: A web based health history questionnaire provides an efficient means to identify patients eligible for cancer screening and offer them DAs before an appointment. Although many patients appropriately chose not to view a DA based on prior knowledge and experience, DA viewing rates among the remaining patients were lower than hoped.