TESTING A COLORECTAL CANCER SCREENING DECISION AID TARGETED TO OLDER ADULTS

Sunday, October 19, 2014
Poster Board # PS1-28

Carmen L. Lewis, MD, MPH1, Christine E. Kistler, MD, MASc2, Carol E. Golin, MD3, Carolyn Morris, MPH4, Alexandra Dalton, PhD1, Maihan Vu, DrPH, MPH5, Stacey Sheridan, MD, MPH6, Rowena Dolor, MD, MSH7, Jessica DeFrank, PhD8, Emily Elstad, PhD5, Russell Harris, MD, MPH3, Colleen Barclay, MPH8 and Noel T. Brewer, PhD5, (1)School of Medicine, University of Colorado, Aurora, CO, (2)Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, (3)School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, (4)Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, (5)Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, (6)Division of General Medicine and Clinical Epidemiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, (7)Division of General Internal Medicine, Duke University Medical Center, Durham, NC, (8)Research Center for Excellence in Clinical Preventive Services, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Purpose: The risks and benefits of colorectal cancer (CRC) screening in elderly populations vary depending on health state and age, suggesting that individualized decision making may be important for CRC decisions. We sought to determine whether a colorectal cancer screening decision aid (DA) targeted to older adults can prepare elderly adults for individualized decision making.

Methods: We recruited patients ages 70 to 84 who were not up to date with CRC screening and were scheduled to be seen in one of the primary care practices affiliated with the Duke practice-based research network. Participants were randomized to a control condition (driving safety booklet) or the intervention group in which participants reviewed a decision aid booklet detailing why CRC screening is different as people age, the potential benefits and risks from screening, competing causes of mortality relative to CRC, and the uncertainty of predicting who will live long enough to have the potential to benefit from screening. These data are part of an ongoing RCT to test the efficacy of the targeted DA in promoting appropriate screening based on health state. For these analyses we report data collected after use of the DA or control booklet but prior to the participant seeing their physician. We measured knowledge using 5 true/false questions, the values clarity subscale of the decisional conflict scale and patient preferences for CRC screening.

Results: To date, 390 patients have been recruited. Mean number of knowledge questions correct out of five was greater in the DA group compared to control (DA 4.1 vs 2.3, p<.0001). The values clarity subscale was significantly lower for the DA group (DA 22.7 vs control 26.8, p=0.02), indicating greater clarity for the DA group. Participants in the DA group were more likely to report that they were unsure about their screening preference (DA 23.6% vs 15.5%) and less likely to endorse a positive screening preference (DA 51.2% vs control 58.8% overall p =.12) but the differences were not statistically significant.

Conclusions: The DA appears to increase knowledge, and improve clarity of values but did not demonstrate a statistical decrease in preference for screening prior to participants’ visit with their provider. The targeted DA may help prepare elderly patients to participate in individualized decision making with their physician.

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See more of: The 36th Annual Meeting of the Society for Medical Decision Making