ENTERTAINMENT-EDUCATION COLORECTAL CANCER SCREENING DECISION AID FOR AFRICAN AMERICAN PATIENTS: A RANDOMIZED CONTROLLED TRIAL
Method: We recruited participants from outpatient clinics at three tertiary care centers. Eligible participants were African American, aged 49-75 years, due for a CRC screening, fluent in English, and had a scheduled office visit. The intervention participants viewed an entertainment-education decision aid with culturally tailored information about CRC screening options and theory-based support in decision making (e.g., role modeling). The Ottawa Decision Support Framework, Integrated Model of Behavior, and the Edutainment Decision Aid Model guided the development of the intervention decision aid. Control participants viewed a video about hypertension, which lacked the culturally tailored information and theory-based support in decision making. Participants met with their clinician and then completed follow-up questionnaires assessing their knowledge, decisional conflict, self-advocacy, attitudes, perceived social norms, and intentions. At three months, completion of screening was assessed by chart review. Analysis included descriptive statistics and ANCOVA.
Result: On average, participants (N=89) were aged 57.6 years (standard deviation [SD]=6.9) and married or in a long-term relationship (49%). They were primarily female (68%), college educated (57%), and privately insured (75%). Viewing the culturally-tailored decision aid significantly increased participants’ knowledge of CRC screening recommendations and options (Intervention: mean ± SD=8.9±3.1 to 11.6±2.4; Control: mean ± SD=9.2±2.9 to 9.6±2.5; p-value<0.01). Intervention participants’ reported lower decisional conflict (Intervention: mean ± SD=11.0±16.7; Control: mean ± SD=39.6±27.7); p-value<0.01) and higher self-advocacy (Intervention: mean ± SD=1.6±0.3; Control: mean ± SD=1.8±0.3; p-value=0.01) compared to control participants. No significant differences were observed in participants’ attitudes (Intervention: mean ± SD=9.7±2.0 to 9.4±2.2; Control: mean ± SD=8.9±1.7 to 8.6±2.3; p-value=0.49), norms (Intervention: mean ± SD=10.5±2.2 to 10.6±1.9; Control: mean ± SD=11.6±2.0 to 10.6±2.2; p-value=0.49), or intentions (Intervention: mean ± SD=12.5±2.1 to 13.0±1.5; Control: mean ± SD=12.1±2.6 to 12.8±1.6; p-value=0.69). At three months, 23% of patients had completed a colonoscopy regardless of group assignment.
Conclusion: Designing targeted, engaging decision aids for groups that have sub-optimal screening shows promise for improving knowledge, decisional conflict, and self-advocacy. Additional research is warranted to investigate the effectiveness of these decision aids in clinical practices on patient downstream behaviors, such as repeat testing.