Nationally, hepatitis C virus (HCV) screening rates are low and many are unaware that they are infected. This study reports on the impact of decision support on patient HCV knowledge, screening perceptions, and screening use in primary care practice.
Method:
Patients of a large primary care practice who self-reported at least one HCV risk factor were eligible to participate at the time of their physician office visit. After completing a baseline survey, a trained health educator guided participants through an HCV screening education and decision counseling session, during which time each participant clarified his or her personal preference for or against screening. Together, the health educator and the participant identified factors influencing screening, rank ordered the most important factors, and elicited specific and relative factor weights. Participants were given a one-page summary report from the decision counseling session to share with their physician during the office visit, to promote shared decision making. Post-visit survey and chart audit data were collected at 10 and 30 days, respectively. Change in HCV knowledge and screening perceptions were measured using baseline and post-visit survey data. Screening was assessed using chart audit data. Multivariable analyses identified predictors of screening.
Result:
Among 91 participants, HCV knowledge increased (p=0.001), and four out of seven perceptions about screening improved (p<0.05). A total of 28 (31%) participants screened for HCV; 26 of these participants indicated that they preferred to screen during decision counseling while 2 participants indicated that they were neutral about screening during decision counseling. Predictors of screening (p<0.05) included being unmarried, having fewer worries about screening, and having a preference for screening.
Conclusion:
After being exposed to the decision counseling intervention, participants exhibited increased knowledge and favorable perceptions of HCV screening. Participants who were unmarried were likely to respond to decision support, as were those who expressed preference for screening. Further research is needed to determine if this strategy can significantly increase the proportion of adults who are screened for HCV infection.