Background: Decision aids can improve decision making processes, but the amount and type of information that they should attempt to communicate is controversial. We sought to compare, in a pilot randomized trial, two colorectal cancer (CRC) screening decision aids that differed in the number of screening options presented.

BackgroundCompeting causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over.MethodsWe used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening.ResultsWe enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening)ConclusionIn an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid.

Background: We sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice.

Background Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DA) as a means of improving their effectiveness, but little research has examined the effects of such exercises. Objective To determine whether adding a VC exercise to a DA on heart disease prevention improves decision making outcomes. Design Randomized trial. Setting UNC Decision Support Laboratory. Patients Adults ages 40–80 with no history of cardiovascular disease. Intervention A web-based heart disease prevention DA with or without a VC exercise. Measurements Pre and post-intervention decisional conflict and intent to reduce CHD risk. Post-intervention self-efficacy and perceived values concordance. Results We enrolled 137 participants (62 in DA; 75 in VC) with moderate decisional conflict (DA 2.4; VC 2.5) and no baseline differences among groups. After the interventions, we found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; VC 1.9; absolute difference VC-DA 0.1, 95% CI −0.1 to 0.3), intent to reduce CHD risk (DA 98%; VC 100%; absolute differences VC-DA: 2%, 95% CI −0.02% to 5%), perceived values concordance (DA 95%, VC 92%; absolute difference VC-DA −3%, 95% CI −11 to +5%), or self efficacy for risk reduction (DA 97%, VC 92%; absolute difference VC-DA −5%, 95% CI −13 to +3%). However, VC tended to change some decisions about risk reduction strategies. Limitations Use of a hypothetical scenario. Ceiling effects for some outcomes. Conclusions Adding a VC intervention to a DA did not further improve decision making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.

BACKGROUND: Experts suggest an individualized approach to colon cancer screening to take into account variation in older adults' life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older.OBJECTIVE: To understand whether physicians employ individualized decision making for colon cancer screening in older adults, and, if so, to determine the individual factors they believed were important to consider in making such decisions. DESIGN: Qualitative research using focus groups and individual interviewsPARTICIPANTS: Fifteen primary care physicians practicing in community settings participated in three focus groups and two interviews. APPROACH:We used two clinical vignettes of 78-yearold women in fair and poor health states to stimulate discussions about clinical decision making for CRC screening in older adults. RESULTS:Physicians considered a wide range of factors, including clinical factors, such as age, life expectancy, co-morbidities, and functional status, as well as individual factors, such as personality, previous screening behavior, family support, and the relationship with the patient. Physicians reported difficulty with these decisions because of their complexity and because they involve life expectancy estimates. Their approach and discussion with patients seemed to be dependent on the degree of certainty they perceived regarding their clinical assessment as to whether the patient had the potential to benefit from screening. CONCLUSIONS:Colorectal cancer screening decision making is complex. Physicians reported using a range of clinical and individual factors to decide about colorectal cancer screening in older adults.KEY WORDS: colon cancer screening; decision making; elderly.