PATIENT PERCEPTIONS ABOUT COLORECTAL CANCER SCREENING AFTER VIEWING A DECISION AID TARGETED TO OLDER ADULTS
Method: We conducted a single-blinded, randomized controlled trial to test the efficacy of a CRC DA designed for older adults. Eligible patients were asked to arrive early for an upcoming clinic visit to receive the DA or control materials. Before seeing their provider, participants completed written questions including: likelihood of discussing screening, physician’s screening preference, preferences for decision making process, life expectancy, likelihood that screening will prolong life, and decisional balance between risks and benefits.
Result: 424 participants ages 70-84 were recruited from 14 primary care practices within the Duke Primary Care Research Consortium. The intervention group was more likely than the control to say they were very/somewhat likely to talk with their doctor about CRC screening (60% vs 44%; p=.001), versus somewhat/very unlikely. In both groups, >78% of participants preferred to share the decision making process with their doctor in some capacity. A greater proportion of patients in the intervention group than the control thought they would live >10 years (47% vs. 39%; p=.12) versus less time, although it was not statistically significant. Patients who received the DA were less likely than the control to believe screening would prolong their lives “a lot” (12% vs. 23%; p=.005), compared to any shorter duration of time. However, >40% of all participants were “unsure” whether screening would prolong their lives. The intervention group was less likely than the control to say the “Benefits greatly outweigh the risks” of screening (30% vs. 46%; p=.001), compared to any other category. There was no significant difference between the groups’ perceptions of their providers’ screening preference.
Conclusion: Exposure to the DA appears to increase patients’ intent to discuss screening with providers. The DA also appeared to affect risk/benefit assessment, perhaps due to increased knowledge about screening. It is interesting that a plurality of respondents in both groups remain unsure about whether screening would prolong their lives. Although not statistically significant, differences in perceived life expectancy may be clinically important, as the data suggest a trend to report a higher life expectancy among intervention patients.